OBSERVATIONS 

ON THE 

CHANGES OF THE AIR, 

AND THE 

CONCOMITANT EPIDEMICAL DISEASES 

IN THE 

ISLAND OF BARBADOES. 

TO WHICH IS ADDED, 

A TREATISE ON THE PUTRID BILIOUS FEVER, 

COMMONLY CALLED 

THE YELLOW FEVER ; 

AND SUCH OTHER DISEASES AS ARE INDIGENOUS OR £N* 

DEMIAL, IN THE WEST INDIA ISLANDS, 

OR IN THE TORRID ZONE. 

BY WILLIAM HILLARY, M. D. 
WITH NOTES, 

BY 

BENJAMIN RUSH, M. D. 

PROFESSOR OF THE INSTITUTES AND PRACTICE OF MEDICINE IN THE UNtVERStTr 

OF PENNSTL VANIA. 

PHILADELPHIA .• 

PUBLISHED BY B. & T. KITE, NO. 20, N. THIRD-STREET* 



JANE AITKEN, PRINTER, 

181L 










DISTRICT OF PEjYNSYLVAVIA, to wit: 

BE IT REMEMBERED, that on the twenty-third 
day of August, in the thirty-sixth year of the indepen- 
j dence of the United States of America, A. D. 1811, Ben- 
jamin and Thomas Kite, of the said district, have depo- 
sited in this office the title of a book, the right whereof 
they claim as proprietors, in the words following, to wit: 
w Observations on the changes of the air, and the concomitant epidem- 
ical diseases in the island of Barbadoes. To which is added, a Trea- 
tise on the putrid bilious fever, commonly called the yellow fever ; 
and such other diseases as are indigenous or endemial, in the West 
India islands, or in the torrid zone. By William Hillary, M. D. With 
Notes, by Benjamin Rush, M. D. professor of the institutes and prac- 
tice of medicine in the University of Pennsylvania." 

In conformity to the act of the congress of the United States, 
intituled, " An Act for the encouragement of learning, by securing 
the copies of maps, charts and books, to the authors and proprietors 
of such copies during the times therein mentioned."— -And also to the 
act, entitled, " An Act supplementary to an act, entitled " An Act 
for the encouragement of learning, by securing the copies of maps, 
charts, and books, to the authors and proprietors of such copies du- 
ring the times therein mentioned," and extending the benefits thereof 
to the arts of designing, engraving, and etching historical and other 
•prints." 

D. CALDWELL, 
Clerk of the District of Pennsylvania. 



3 ':■■ 



DEDICATION. 



TO THE STUDENTS OF MEDICINE, IN THE UNIVERSITY OF 
PENNSYLVANIA. 

Permit me, Gentlemen, to conduct you to another 
of those fountains of practical knowledge in medicine, which 
have been opened by the history of epidemic diseases. 

The physician, to whose patience and labour we are in- 
debted for performing that useful task by means of the 
following work, was a pupil of the celebrated Dr. Boerhaave, 
from whom he learned the necessary connection of theory 
with experience in the practice of physic. It is true, some 
of the theories he adopted, from his illustrious master, have 
been discovered to be erroneous, but the facts he has re- 
corded in his history of the weather, and of its effects upon 
the symptoms, and cure of diseases, will be true, in like cir- 
cumstances, in all ages and countries, nor will they be af- 
fected in their importance or utility by any of the successive 
revolutions which may take place in the principles of our 
science. 

There is the same difference between the knowledge 
which is acquired by studying the histmies of epidemics, and 
that which is obtained by reading abstract treatises upon 
diseases^ in their respective influence upon the practice of a 



DEDICATION. 

physician, that there is between example and precepts in 
forming a moral character. The latter apply to the under* 
standing only, while the former apply to the understanding 
and will, so that correct practice becomes, as it were, invo~ 
luntary in both cases. 

The Notes of the Author are distinguished in a few 
instances by numbers, and in all of them by the usual marks 
of reference. The Notes of the Editor may be known by 
numbers only. 

With great respect, I am, Gentlemen, your sincere well 
wisher. 

BENJAMIN RUSH. 

August 16th, 1811. 



PREFACE. 



THE following observations on the changes of the 
air, and variations of the weather, were made in the 
island of Barbadoes, with care and exactness, and are 
truly related. 

The degrees of the heat or the coolness of the air 
were observed by Fahrenheit's mercurial thermometer, 
made at Amsterdam, every morning at or before the rising 
of the sun, and again between the hours of twelve and 
one o'clock at noon. And the height of the mercury in the 
barometer was observed at the same times, though I have 
only recorded its station at noon ; and I should have be- 
gun these observations some years sooner, if an accident 
had not deprived me of my barometer ; but if I had 
known that the variations in it had been so very little, within 
the torrid zone, as I found them afterwards, I should have 
made them without it ; as the greatest variation in it, in 
six years time, was never more than four tenths of an 
inch, viz. from twenty. nine six tenths of an inch high to 
thirty inches. I also made use of a hygrometer to ob- 
serve the degrees of moisture and dryness of the air, but 
found its variations to be so immaterial, except when the 
rains fell, and were visible to our senses, as not to be 
worth recording ; especially as the quantity of rain which 

A 



ii PREFACE. 

fell in each month is recorded : but as it is observed that 
much more rain usually falls in mountainous places, 
than in flat, low, level countries, and Bridgetown being on 
a level plain, and they often had rain on the hills when 
we had little or none; and my worthy and ingenious 
friend Andrew Dury, whose seat is on the rising hills 
near the medium between them, having carefully meas- 
ured the quantities of the rain which fell in each month, 
for some years, and reduced it into cubic inches and the 
decimal parts of an inch in its depth ; his observations 
and measurement, where he is situated, may be taken as 
a medium for the whole island ; and he readily obliged 
me with a table of the quantities of rain which fell in 
six years, for which I now return him my grateful ac- 
knowledgments. And I think that the changes of the 
air and weather, as well as the quantity of rain falling, 
may be depended on, as being very exact. 

So likewise the succession, as well as the variations of 
the concomitant epidemical diseases, were as carefully 
observed in my practice, at the same time, and recorded 
at the end of each month ; that I might if possible ob- 
serve, how those diseases were either influenced, caused, 
or changed, by those variations of the weather ; which 
when they were evident, material, or important, I have 
occasionally observed and remarked ; as also such vari- 
ations, either in the method of curing those diseases, or 
such alterations in the medicines given, as I found were 
necessary, and the success they had ; all which I have 
endeavoured carefully to relate. I do not here mean such 
alterations, either in the methods of cure, or in the medi- 
cines, or their doses, as are necessary to be made, in differ- 
ent patients, or different ages and constitutions ; as the dif- 



PREFACE. iii 

fcrence between a patient* who has strong, rigid, and 
elastic solids, and a dense blood ; and one who has a de- 
licate, slender, or a relaxed weak state of his solids, and a 
lax, loose, unconnected state of the globules of his blood ; 
nor the difference between one who has a viscid, sizy, or 
buff like blood, from one who has a lax, putrescent, dis- 
solved state of blood ; for all these different constitutions 
may possibly have the same epidemical disease, at the 
same time, but with different symptoms, and may require 
different methods of cure, both as to the quantity of 
bleeding and other evacuations, as well as different medi- 
cines, though it be the same disease, and arises from 
the same epidemical cause ; as every judicious physician 
knows. But I mean such changes in diseases, as arise 
from the variations in the weather, and either produce 
different symptoms in the same disease, or such as may 
determine the morbid matter to a different part of the 
body ; or lastly, to be carried off by a different critical 
discharge, than it was before ; all which should be care- 
fully observed by the attending physician, and nature 
should always be assisted by him, to effect such ways 
and methods as she indicates and endeavours to do, if it 
can be done ; these I have endeavoured to observe : 
as also when those changes in the weather have either 
put an end to the then reigning epidemical diseases, or 
have produced some other diseases which did not appear 
before ; and when these changes were any way consider- 
able, or of any importance, I have taken care to mention 
them, as well as such changes in the methods of cure, or 
in the medicines, as I found necessary to be made, es- 
pecially those which I found to be the most successful 



iv PREFACE. 

Though I have given but few or no formulae or 
prescriptions, because the same form or prescription can 
but suit a few patients, or constitutions, without some 
alterations in them pro re nata ; and therefore could not 
be of much service to such practitioners as are qualified 
either to prescribe, or administer any medicines ; and a 
prescription to the judicious is unnecessary, because, as the 
great Hippocrates says, he who knows the disease, knows 
what is proper to cure it. And as for those who will neither 
read, nor yet know how to reason on the causes, or the 
manner of their production of diseases,and yet will boldly 
practise by rote, and prescribe by guess at a venture, 
though the life of the patient depends on the right or 
wrong method of prescribing ; I must with the learned 
and judicious Dr. Huxam, seriously advise them, at least 
to peruse the sixth commandment. 



INTRODUCTION. 



THAT wise father and prince of physicians, Hippo- 
crates,* advises all physicians to examine and duly con- 
sider the situation, air, and the water, used by the people 
of such cities, or places, as they are called to, or may 
practise in. It is therefore necessary that I should say 
something concerning the situation, air, water, &c. of 
this island, before I give an account of the observations 
made on the epidemical and endemial diseases in it, at 
least for the satisfaction of such of my readers as are 
strangers to it. 

Barbadoes is a small island, near 26 miles long, and 
near 14 broad, situated in the West Indies, in lat. 13 N. 
and long. 59 W. from London, and is one of the Caribbee 
Islands. It is most of it pretty high rocky dry land; the 
soil is usually about two feet deep, in some places less, 
in others more, and mostly consists of a blackish mould, 
in some places red. It has but few springs of water, and 
only one rivulet which deserves that name : no marshy or 
wet lands of any importance, the whole Island being in 
general rocky and dry ; yet the inhabitants have plenty of 
good spring- water, by digging into the rock, all over the 
island, though it is most commonly a little hard: the 
rock is in general composed of a soft porous white free- 

* Hippoc. de Acre, Aquis et Locis. 



vi INTRODUCTION- 

stone, in some places a lime-stone; in others it consists of 
brain-stones, astroites, and stalactite concretions. In the 
north east part of the island there are mun-jack pits, from 
which the petreoleum, called Barbadoes tar, is gotten, 
and near them iron ore is found. The air is generally 
pure, serene, and dry, except in the rainy seasons, but al- 
ways very warm. 

The inhabitants who live temperately, and are prudent 
in the use of the six non-naturals, if they have tolerable 
good natural constitutions, live to as great an age as the 
Europeans. Some have died here lately, who were above 
a hundred years old ; but those who live irregularly, and 
are too free in the use of vinous and other spirituous li- 
quors, generally hasten their end more expeditiously, than 
they who live in the same manner in Europe. But I must 
observe, in justice to and honour of the fair sex, that they 
all in general are exceeding temperate, and very few or 
any of them drink any thing but water, and generally live 
to a good old age. (1) 

The Europeans and North Americans, from the colder 
parts of it, and especially the Britons, when they first 
come to this or the other West India islands, are, by the 
great increased heat of the climate, usually not long after 
their arrival there seized either with a fever, or with a sort 
of ex^W* efflorescences, which most commonly first ap- 
pear on the legs, in pretty large hard lumps of a redish 
colour, which are sometimes as large or larger than a 
shilling, but of an irregular figure, and itch violently, 
especially towards night, if they are either rubbed or 
scratched; and from doing which it is difficult to refrain, 



(1) A sedentary life, in which the body is protected from the 
rays of the sun, may render simple water the most proper drink 
for the preservation of health, but labour can seldom be sus- 
tained for any length of time, in the open air, in a hot climate, 
without drinks of a more cordial nature. These should be 
wine and water, diluted malt liquors, or molasses and water 
with a little vinegar in it; ardent spirits should not be tasted: 
they render the heat of the sun more ^insupportable and more 
injurious to health. 



INTRODUCTION. vii 

though doing either much increases both the itching and 
their swelling, and often either rubs the cuticle off, or 
causes little blisters to rise, and a saltish yellow serum to 
oose out, which makes them smart; after which a scurf 
or scab ensues, which after a few days fall off: these lumps 
commonly rise on the hands, arms, legs, thighs, neck, and 
face, and usually continue three, four, or five days, then 
turn to a yellowish colour, and soon after disappear; but 
are soon succeeded by others in or near to the same places, 
and so continue successively for several weeks, or months, 
in most strangers which come into this hot climate. 

These exanthematous eruptions, are vulgarly but er- 
roneously ascribed to the stinging or biting of the mus- 
quetoes. It is certain that these insects do bite, and that 
little lumps or swellings will rise where they bite, but 
these are neither so large, nor do they usually continue so 
many hours, as the other lumps do days : these being 
only the bite of a small insect, which is not more offen- 
sive than the bite of the midge in England ; whereas 
the other are efflorescences cast out by nature, or the 
vis vitas, and proceed from the great increased heat of 
the climate, which continuing rarifies and expands the 
circulating fluids, and so exalts, semivolitilises, and alka- 
lises their natural soft, mild, semiamoniacal neutral ani- 
mal salts, as to render them very acrid, and unfit to pass 
through the small subcuticular vessels and secretory 
pores, without obstructing them, and producing those 
troublesome itching tumours. 

Whilst these efflorescences continue, there are also other 
but smaller eruptive pustular, or little red pimples, which 
arise from the same cause, often come out all over the 
rest of the body, called li$ x by the Greeks, essera by the 
Arabians, sudimina by the Romans, and the prickly heat 
by the English, which cause great itching and pricking, 
as if with small needles : this usually continues several 
weeks, and in some persons for some months, in the hot- 
ter months, and then declines, and causes the cuticle to 
fall gradually off in small white scales. This prickly heat 
seizes most of the inhabitants, both natives and strangers, 
either in a greater or lesser degree, every year during 



viii INTRODUCTION. 

the hot summer months. It seldom causes any sickness 
or disorder, except the troublesome itching and pricking, 
but every one goes about his business with it, as if he 
was well ; unless it be imprudently repelled and struck 
suddenly in, either by rubbing it with lime juice, vinegar, 
camphorated spirits, or by washing the body with cold 
water, which some are so imprudent as to use, to take 
that troublesome itching and pricking heat off', whereby 
they have repelled those acrid saline humours into the 
blood again, when kind nature had thus cast them out, 
and so have produced a fever, which has sometimes 
been attended with bad consequences. For going into a 
cold bath, or the sea, is not so bad or dangerous in this 
case, as washing the body with cold water is ; for though 
the humour may be repelled, whilst they are in the cold 
bath, yet the glowing heat which usually follows it, strikes 
it more effectually out again after, which washing with cold 
water does not.(2) The best method is to live temperate- 
ly, use moderate exercise, and encourage the eruption by 
taking small warm liquids and nourishments, as gruel, 
tea, coffee, wine whey, broth and plain meats ; and to 
avoid suddenly exposing themselves when warm to a cur- 
rent of cool air, night dews, and damp wet places, and 
the too freely drinking spirituous liquors, as they increase 
this as well as inflammatory diseases. 

For I have observed, that not only the yellow serum 
which those little tumours or blisters oose out, but the 
common sweat, even of persons who are well, when tast- 
ed in this hot climate, is so very salt and acrid that it 
tastes like the salt or spirits of hartshorn mixed with 



(2) This remark is founded in reason. The whole system re- 
acts in a regular manner, from the application of cold water and 
cold air, to every part of the body; but partial reaction, of an 
irregular morbid nature, takes place from their partial ap- 
plication. The Spaniards in Cuba, Don Ulloa tells us, when 
partially wetted by a transient shower of rain, prevent fevers 
by plunging themselves into the first creek or pond of water 
they meet with. The water, in this case, produces general and 
healthy reaction. 



INTRODUCTION. ix 

water in a considerable proportion, which being retained 
in or repelled into the blood, must attenuate and dissolve 
it, and stimulate the solids also, and produce not only 
this depuratory fever, but if continued, the yellow putrid 
fever or other putrid fevers alSo. 

Moderate bleeding, and a free use of gentle acidantiphlo- 
gisticks, and sometimes some other evacuations, and en- 
couraging a free diaphoresis, generally takes this feVer 
off; but a great languor and want of spirits and strength, 
often continue for some time after it. And it is remarka- 
ble, that in this hot climate the sick seldom recover from 
any fever, or other sickness, so soon as they usually do in 
England, or other colder countries. 

Notwithstanding that the air is generally clear and 
serene, (except in the rainy seasons) yet the heat is gen- 
erally so great, as never to cause the mercury in Fah- 
renheit's thermometer to fall lower than seventy de- 
grees, in the coolest mornings, or higher than eighty- 
six in the day time ; yet as the greater degree of 
heat usually continues eight or nine months in the 
year, it must greatly relax the animal fibres, especi- 
ally when it is accompanied with moisture, as in the 
rainy seasons, and give a putrescent diathesis to the flu- 
ids : both which must greatly tend to attenuate and dissolve 
the circulating fluids; and it is observed that the blood in 
general is much more lax, loose, and attenuated, even in 
health here, than it is in England: ( 3 ) hence the disposition to 
putrid fevers and other diseases from thence arising, may 
be seen. But this last state of the fibres has its advantages 
in this climate, as well as its disadvantages : for if the 
fibres were not thus relaxed, but were to continue in that 
clastic active state, which they are usually in, in colder 
countries, every extraordinary motion and exercise, ac- 
companied with that great heat, would bring on a fever 
of the inflammatory kind, with greater or less violence, as 



(3) The stimulus of heat, like all other stimuli, weakens the 
cohesion of the fibrin of the blood, for which reason we rare- 
ly see sizy blood in very hot weather, in fevers, which notwith- 
standing, require blood ktting to cure them. 

B 



x INTRODUCTION. 

these procatarctic causes were greater or less. But let us 
not imagine, that a general relaxation of the solids attends 
every one, in the same degree, because the same degree 
of heat equally affects all; for some are much more re- 
laxed than others from the same cause, and different con- 
stitutions differ as much here as they do in England, 
or elsewhere, though none may have their solids so elas- 
tic here, as the same person would have them there. 

Having said thus much on the climate, and the effects 
of the variations of the weather on the human body, I 
must make some remarks on the customs of the coun- 
try, particularly on those which do, or may affect the 
health of the inhabitants. 

I am well informed, that it was the custom of the first 
comers hither, to wrap and swaddle up their new-born 
infants in linen and flannel in this hot climate, as they did 
in England, by which it is probable that several of them 
must have lost their lives innocently and ignorantly ; and 
those who were strong enough to survive it, must 
have been so relaxed and weakened by it, as to render 
them weak and sickly a great part of, and some of them 
all, their life time after. But this practice is, in a good 
measure left off, though not near so much as it should 
be ; for the mid wives and nurses still continue to use a 
great deal more clothing and wrapping than is proper, 
and do not use washing and bathing their infants in cold 
water, near so much as they should, whereby many are 
rendered sickly, weak, tender, and pale, all, or a great 
part of their life time after. Whereas, if they used cold 
bathing in a proper manner, not only to infants, but all 
others, except the very ancient people, it would greatly 
contribute not only to brace up and strengthen their relax- 
ed solids, but to* prevent all those diseases which arise 
from thence : and we find that all the eastern warm na- 
tions use cold bathing frequently, if not daily, and no 
doubt have found the benefit of it for many ages past; and 
if the inhabitants of the West India islands would follow 
the same practice, they would find the same advantage 
from it also. 

Fashions and custom are two prevailing things, which 
enslave the greatest part of mankind, though often both 



INTRODUCTION. xi 

contrary to reason and conveniency, and particularly in 
our dress: for no doubt but the loose, cool, easy dress of 
the eastern nations, a thin loose gown or banjan, is much 
easier, and better fitted for us in the hot climate, than the 
English dress ; and all who have tried both find it so : 
but such is the influence of fashion and custom, that I 
have seen many men loaded, and almost half melting, 
under a thick rich coat and waistcoat, daubed and loaded 
with gold, on a hot day, scarce able to bear them, little 
considering how much they injured their constitutions 
thereby, as well as their being troublesome. 

A banjan is the dress of the Mandareens, and at the 
courts of China, Japan, Indostan, and Persia, and some 
other courts; and why it may not be so at Barbadoes, 
and the other hot islands, I see nothing but custom to 
hinder it: and if any one cannot part with his finery, and 
thinks the character of a fop preferable to that of a man 
of sense and honour, he may daub his banjan with as 
much gold as he pleases. But after all, I think it is the 
most convenient dress in all hot countries, and the best 
suited to preserve their ease and health. (4) 

I must also say something of exercise, as that, when 
prudently used, contributes much to the preservation, and 
in some cases to the restoration of health. But as no rural 
diversions, such as are used in England, can be followed 
here, because we have little or no game, and if we had, 
the country is too hot to pursue them ; wherefore riding, 
walking, and dancing, ate the only exercises here used: 
the two first, when taken in moderation, at suitable 
hours, viz. mornings and evenings, when the air is a little 
cooler, do no doubt contribute much both to the preser- 
vation and restoration of health in some cases, as also 
does navigation in some others; but dancing is much too 
violent an exercise in this hot climate, and many do greatly 
injure their health by it, and I have known it fatal to some; 



(4) The author's remarks upon the propriety of accommoda- 
ting dress to climate, deserve our attention. * Many thousand 
Europeans, and particularly soldiers, have been sacrificed to 
the thick and heavy dresses worn in European countries. 



xii INTRODUCTION. 

neither is it used in the eastern hot countries : but most of 
the ladies are so excessive fond of it, that say what I will 
they will dance on. 

As to the diseases of this and the other West India 
islands, there are several both acute and chronical, which 
are indigenous or endetnial in them, and probably to such 
other countries as are situated within the torrid zone, 
which are scarce ever seen, and are but little known in 
England, or the other European nations. I have endea- 
voured carefully to observe those diseases, and strictly 
enquired into them, and shall delineate them in such a 
manner, that they may be known when seen by those who 
have not seen them before. I have also recommended 
such methods of cure as I have found to be the most suc- 
cessful, as also the manner of giving those medicines 
which I have found to be the most efficacious in their 
cure ; and I have added some formulae or prescriptions 
in the second part, for the benefit of such young practi- 
tioners as may not be acquainted with the usual method or 
manner of giving them. But I must observe, that neither 
these, nor any other formulae or prescription that can be 
given, can no more suit all constitutions or cases in the 
same disease, than one coat can be made to fit all men ; 
for these must be varied according to the different causes, 
circumstances, and natures of the symptoms of the dis- 
ease, as well as to the different ages, strengths, and consti- 
tutions of the patient, by the judicious physician, as he 
may see necessary. 

In the first part I have given an account of the weather, 
and ail its material changes, as I observed them by 
Fahrenheit's mercurial thermometer, and a common por- 
table barometer, and also have given an account of the 
quantities of rain which fell in each month and year, and 
the other visible changes in it; and an account of all the 
concomitant, endemial and epidemical diseases, and such 
variations as happened in them, as were any way remark- 
able or material, together with their indications and inten- 
tions of cure, generally taken ex ipsa re & ratione and 
such methods and medicines as I found to be the most 
successful in their cure, And I have remarked wherein 



INTRODUCTION. xiii 

those diseases differed from the same diseases in En- 
gland, when any such happened to appear, that were any 
thing material or remarkable, either arising from the heat, 
or other variations of the climate ; as also such variations 
as I found it necessary to make, either in the method of 
treating those diseases, or in the medicines, when it was 
different from the method of treating them in England ; 
and I have mentioned such as I found to be the most sue- 
cessful, in as plain, clear, and full a manner as I could, 
without being too tedious, in order to adapt it to the 
capacity of the unlearned, as too many of the apothecaries 
in this part of the world are too much so, that it may be 
more generally useful to mankind, and in particular to 
the inhabitants of the island of Barbadoes, for whose be- 
nefit and service I have chiefly taken all this labour ; and 
I sincerely wish that this performance may be as use- 
ful and beneficial to them, and all the other West India 
islands, as either they or I can desire* 



OBSERVATIONS 



3N THE 



CHANGES OF THE AIR, &c. 



THE months of March, April, and May, were more 
than usually warm and dry, little rain falling in all that 
time, insomuch that the whole quantity which fell in these 
three months, was only equal to K22 cubical inch deep. 

And the lowest that Fahrenheit's thermometer was at 
sun-rise was in the month of March at 74, and the high- 
est in the morning at 78, and the lowest at noon was at 80, 
and the highest at noon was 82. In April the lowest in the 
morning was 76, and the highest in the morning at 79, 
and the lowest at noon was 81, and the highest at noon 
was at 82. In May the lowest in the morning was 77, 
and the highest in the morning at 81. And the barometer 
in these three months was 29.8, the highest 29.9. 

During this warm dry season, inflammatory diseases 
were very frequent, chiefly ophthalmies, quincies perip- 
neumonies, and pleurisies ; in all which the pulse was 
mostly full, quick and hard, and their blood generally infla- 
med; and in most it was covered with a starch or buflf- 
like inflammatory pellicle: but I must 'observe, that their 
blood in these inflammatory diseases, is very seldom so 



16 ON THE CHANGES OF THE AIR, &c. 

much sizy or buff-like in this warm climate, as it usu- 
ally is in England when the pain and height of the inflam- 
mation, and the other symptoms are nearly the same.* (5) 

These generally required larger bleeding than in most 
other years, unless equally hot and dry; but by bleeding 
pretty freely, and a liberal use of antiphlogistic medicines, 
with sal. nitre and crude sal. ammoniac, as hereafter 
mentioned, and diluting plentifully, they were generally 
relieved; and I found emollient fomentations, with crude 
sal. ammoniac, were of great service. 

The small pox also were epidemical at this time, but 
were in general of the distinct kind; and those few who 
had the confluent sort, were generally of a good kind, not- 
withstanding that the above inflammatory diseases were 
then epidemical. 

The beginning of June was also very dry and warm; 
but from the middle of it to the end of it, and during the 
months of July and August, we had frequent and much 
rain. The quantity of rain which fell in June was = to 
10.03 cubic inches deep. The lowest that the thermome- 
ter was in the mornings was at 77, and the highest it was 
at or before syn-rise in the morning, was 80. The lowest 
it was at noon was at 82; and the highest at noon was 84. 

The quantity of rain which fell in July, was=to 8.48 cu- 
bic inches deep; and the lowest that the thermometer was 
at in the mornings was at 78, and the highest that it was at 
in the mornings was at 80. The lowest it was at noon was 
at 82, and the highest at noon was 86. 

The quantity of rain which fell in the month of August, 
was=to 8.72 inches deep. The lowest the thermometer 



* S>uerij. Does not this difference most probably arise from 
their solids here being more relaxed by the heat of the climate, 
than they are in England ? Whence their fluids are more lax, 
and more readily attenuated, or dissolved, by the alkaline ac- 
rimony of the semivolatilized animal salts. 

(5) Here we meet with another fact in support of great heat, 
by its stimulus, lessening the quantity of sizy in the blood, in 
fevers of great morbid action. We see further, the influence of 
hot and dry weather, in producing high toned diseases. It acts 
uniformly in this way in all countries. 



IN THE ISLAND OF BARBADOES. 17 

was in the mornings was at 79, and the highest that ever 
it was in the mornings was at 82. The lowest it was at 
noon was 83, and the highest at noon was 86; and the low- 
est that the mercury fell in the barometer in these three 
months was to 29.8, and the highest that it ever did arise 
to was 29.9. 

Upon the falling of thus much rain, the face of the earth 
which was much parched and burned brown before, soon 
became green and pleasant; as vegetation is very strong 
and quick here, whenever much rain falls. 

Upon this change of the weather from very dry to ve- 
ry wet, dysenteries became very frequent and epidemi- 
cal; as they do usually every year upon much rain falling 
at this time of the year, and seized many both white and 
black people, but especially the latter, who are often but 
little clothed, and more exposed to the inclemency of the 
weather, and some of them but poorly fed. (6) We had still 
some few pleurisies and peripneumonies, but these be-- 
came less frequent, and the quincies and ophthalmies 
ceased to appear upon the falling of the rain. 

A cholera morbus also seized several, but I think its 
symptoms are less violent here, than they usually are in 
England: and some were seized with apoplexies and 
palsies, and some of the first died before any proper as- 
sistance could be called in. 

Many children w r ere seized w r ith an aphthous fever,* 
in which the aphthae w r ere most commonly of the white 

(6) The prevalence of dysentery is very common after rain, if 
it be attended with a cool or cold atmosphere. The dysentery 
in this case, affected the blacks more than the whites, from a 
cause which acts uniformly in all climates. 

* ^uery. Was not both the dysentery and this aphthous fe- 
ver, caused by the falling of so much rain, and rendering the 
air cooler, by which the great perspiration and sweating, caused 
and continued by the long continued dryness and heat before, 
being suddenly abated and stopped ; were they not now turned 
upon the bowels, and the humours being rendered acrid by that 
heat, so produced these diseases ? And, 

§>uerif 2. Were not the apoplexies and palsies also produced 
by the same causes, viz. a diminution or stoppage of perspi 

c 



is ON THE CHANGES OF THE AIR, &c, 

or yellowish kind, and rarely black, or of a bad kind, 
unless they were wrong treated; it usually came on with 
a moderate fever, a quick but not very high pulse, and 
was attended with a diarrhoea, but not much pain in the 
bowels; and as dysenteries were than frequent, some 
ignorant practitioners treated it as such, and gave them 
strong restringents (though not good practice in that case) 
which increased the fever and inflammation of the bowels, 
and brought on a mortification which proved fatal. But 
when this fever was treated with small doses of rhubarb 
with gentle anodynes, to carry off the acrid humours, and 
abate the irritation and pain, and gentle antiphlogisticks 
with anodynes, to take off the fever, and restrain or pre- 
vent the too violent purging; and then giving soft, smooth, 
healing balsamicks, as sperm, cet. cremor. lactis, or the 
wax emulsion, with a little syr. meconio, to heal theprimee 
Tire, they generally recovered. As the morbid humours, 
being rendered acrid by the preceding dryness and heat, 
and now being turned upon the bowels, by the cooler rain 
stopping or diminishing the free perspiration and sweating; 
it was necessary to assist nature to discharge those acrid 
humours, by such ways as she indicated, and not to hin- 
der her; though it might be necessary to prevent the evac- 
uation from being too violent, or too sudden and great. 

The month of September continued to be very wet, and 
more cool than the preceding months, though we had some 
calm hot days in which we had much thunder and light- 
ning, and much rain. 

The quantity of rain which fell in this month, though it 
had but 19 days in it, by reason of the change of the style 
made this year, and begun in it, was=to 7.89 cubic inches 
deep; and the lowest the thermometer was in this month 



tion and sweat, by which a plethora or fulness, and the quanti- 
ty of the circulating fluids was too much increased, and the ves- 
sels of the brain making the least resistance, the fluid too vio- 
lently distended or broke them ; as no other evacuations were 
sufficiently increased to cany off that plethora ; either from a 
want of more acrimony in the fluids, or too great a relaxation 
and inability of the solids, to produce such evacuation. 



IN THE ISLAND OF BARBADOES. 19 

in the morning was 79, and the highest it was in any mor- 
ning was at 84; the lowest it ever was at noon was 82, and 
the highest was at 86. The barometer was never lower 
than 29. 7±, nor higher than 29.9. 

A catarrhous fever seized several people in this month; 
they at the first complained of a pain in their head, and all 
over in their limbs, accompanied with a violent cough, by 
which a thin acrid phlegm was expectorated, thoughbut lit- 
tle in quantity, and brought up with much difficulty ; some 
had a brisk fever with it, others had only a small fever, 
their pulse small, quick, and low, and in some a little lan- 
guid, and their extreme parts rather cold than warm, some- 
times with flushing heats, and then cold again, and some- 
times shooting, darting pains, which were soon over, and 
often returned again. (7) 

Bleeding those who were more plethoric and the fever 
higher, with pectorals and antiphlogisticks and a few vola- 
tiles, generally took it off; but more attenuating and warm- 
er pectorals, with a more liberal use of volatiles, as also 
vesicatories, were necessary to those who were more low 
and languid, and where the pulse and fever were lower, were 
of great service and generally successful; and the dysentery 
still continued to be epidemical, and we had some few in- 
flammatory diseases still, though but few of these now. 

The month of October continued to be very wet, and 
much cooler than usual, at this time of the year. The 
quantity of rain which fell in this month, was— to 12.14 
cubical inches deep; and the lowest that the thermometer 
was in any morning in it, was 78, and the highest that it 
rose to in any morning was to 82. The lowest it was at 
noon was 81, and the highest at noon was 85: and the 
lowest the barometer was at 29.8, and the highest was at 
29.9. 



(7) The disease thus happily described by our author, ap- 
pears to be an influenza. In a subsequent page it will appear 
that it spread, in the succeeding month, over the whole island, 
accompanied in some instances^ with pneumonic symptoms. 



20 ON THE CHANGES OF THE AIR, &c. 

The weather continuing to be wet and cool, several 
were seized with an irregular, ingeminated, intermit- 
ting, quotidian fever; which at the first generally put on 
the appearance of a continued remitting fever, but in two 
or three days time usually changed to an ingeminated quo- 
tidian, with all the symptoms of that fever, as usual in 
England*. 

When this fever was treated by bleeding once, and an 
emetic after it, at a proper distance; and then with saline, 
saponaceous draughts after that; as sal. absinth, succus 
limon. &c. or rather with sal. absinth, brought to a neu- 
tral state with elix. vitrioli acid. q. s. in a little aq. men- 
thee, &c. which I found to be better in this case, the fe- 
ver was generally carried quite off by a critical sweat on 
the seventh or ninth day; or in some few it came to inter- 
mit regularly after that time, and then was soon cured by 
the cortex peruv. given with the above saline draughts, 
and rarely effectually without them. Though these irregu- 
lar ingeminated fevers often remitted, and sometimes 
seemed to intermit, yet if the cortex peruv. was given too 
soon in the disease, before it intermitted regularly (as I 
have more than once seen where it had been injudiciously 
given) it generally caused the fever to become continual, 
and mali moris; which sometimes produced obstructions 
in some of the glands of the viscera, or elsewhere, which 
were irremoveable, and either ended in a suppuration, or 
a mortification of the part, as I have several times seen 
and predicted, that it would be so; as the learned Dr. 
Boerhaave very judiciously observes. 

The symptoms of this fever here, were much the same 
as they usually are in the avnyjts, or continued remitting 
fever in England; except only, that the urine in this hot 
climate, never deposits any latericious sediment in this fe- 
ver, nor very rarely in any intermitting, or any other fever, 



^ Query 3. Were not these irregular remitting or intermit- 
ting levers, as well as the preceding catarrhous fever, produced 
by the continuance of the moist, wet season relaxing the solids, 
and rendering them less active, and a diminution of the perspi- 
ration and sweat at the same time ? 



IN THE ISLAND OF BARBADOES. 21 

except sometimes when a crisis happens that way, as it is 
commonly observed to do in England; where a latericious 
sediment in this fever generally denotes the fever either to 
intermit, or so far to remit, that the cortex peruv. may 
be safely given with success; but not so here. (8) 

I must observe, that intermitting fevers, especially ter- 
tians and quartans, are very rarely or never seen in this 
island now, (9) unless they are brought hither from some 
of the leeward islands, or some other places which are less 
cultivated, and not yet cleared of the woods; where inter- 
mitting fevers are said to be much more frequent, and are 
often attended with obstructions of the glands of the visce- 
ra; and when injudiciously treated, and the cortex too 
hastily given before the obstructions are removed, they 
are frequently thereby rendered irremoveable, and are 
changed into chronical diseases, which are at the best ex- 
tremely difficult to be cured, or too often become fatal. 

Some were seized with ophthalmies, and several with 
tumors about the jaws, neck, and head; others were seized 
with a moderate fever at the first, attended with a dull, hea- 
vy pain in the head; the pulse was quick, but low and op- 
pressed, though no great degree of heat attended it, yet in 
a little time they became delirious, and insensible of their 
condition; their strength soon sunk, uncommonly, and a 
stupor came on which gradually increased, and took them 
off in four or five days time; as if all the vital springs were 
stopped at once by the afflux of the humours upon the 



(8) The absence of a sediment in the urine, in the fevers of 
hot climates, deserves our notice. It shows the centrifugal de- 
termination of the fluids in the body, and explains the reason 
why the African and Asiatic plague appears with bubos, car- 
buncles, and other morbid appearances, upon the skin, while the 
lever, from the same cause, in cold and variable climates, by a 
contrary determination of the fluids, produces viseral evacua- 
tions and obstructions. 

(9) The more rare occurrence of intermissions in the fevers 
of hot climates, than in those of middle latitudes, has been ta- 
ken notice of by many writers. It arises from the more uniform 
impressions of heat upon the body. 



22 ON THE CHANGES OF THE AIR, &c. 

brain*. Neither did bleeding, or other evacuations down- 
wards, seem to make that revulsion, or give that relief, 
which they usually do in similar cases; nor was the use 
of volatiles, &c. or vesicatories of that service as they ge- 
nerally are in such cases. (10) 

The rain still continuing, the before mentioned infiam- 
matory diseases totally disappeared ; but the dysenteries 
still continued to be very frequent and epidemical, seizing 
many of the negroes (11) and several of the white people al- 
so: in some it came on ffrstduallv. with little or no fever at 
the first, nor any violent symptoms, but the stools became 
more and more frequent, and the fever gradually increased, 
though some had not much external heat, yet inwardly 
were feverish and hot : in others the fever came on soon- 
er and with more acute symptoms, and the griping and 
pains were great, the pulse very quick, and in some full : 
they generally had a sickness and a load, or loathing at 
their stomachs, pain in their heads, and often all over the 
body; not much griping at the beginning, but it gradually 
increased, and became severe and painful, especially be- 
fore going to stool ; great quantities of blood were gene- 
rally discharged that way, and a bloody mucus after it: and 
as the disease advanced, most of the symptoms increased, 
and sometimes a singultus, with a coldness of the extreme 
parts came on, which are always in this disease very bad, 
and sometimes fatal symptoms, and if not timely relieved, 
too often prove mortal. Also as the disease increases, a 

* §>iieru 4. Were not those humours which produced those 
tumors and swellings in the others, turned or cast upon the 
brain or its meninges, in these, and produced these effects ? 
As the humours seemed to have an unusual tendency and af- 
flux towards the head at this time. 

(10) We have here a striking instance of an insolated dis- 
ease. The sympathy of the system, in such cases, is suspended 
or destroyed. The disease can only be removed by remedies 
applied to the parts affected. 

(11) Perhaps the vapid vegetable diet of the negroes, predis- 
posed them to the dysentery more than the whites, who lived 
upon more cordial aliment, which, by giving tone to their bow- 
els, obviated the predisposition to that disease. 



IN THE ISLAND OF BARBADOES. 23 

terrible tenesmus comes on, and increases so as to be ve- 
ry painful, and often will continue several days, even after 
the frequency of the stools is abated. 

This distemper may be truly said to be endemial in 
the hot climate, and this island, as we have it more or less 
every year, when the rainy seasons come on : as the hea- 
vy rains which usually fall at those times, and the cool- 
ness and moistness in the air which they produce, too 
suddenly check and stop the discharge by perspiration 
and sw r eat, which in this warm climate are usually very 
great, the humours are thereby too suddenly turned upon 
the bowels ; to which may be added as a concomitant 
cause, their too freely eating the herbs, roots, and fruits 
of the earth, which are too hastily and luxuriantly produ- 
ced in this warm climate, upon the falling of such rain, 
and are then crude and waterish, which the negro slaves 
too voraciously devour ; and who are at the same time 
too much exposed to the inclemencies of the weather, and 
hard labour in the fields, and some of them ill-cloathed ; 
all which jointly contribute to produce this disease : and 
I have observed that the negro slaves are generally the 
first seized with such diseases as are epidemical or ende- 
mial in this island. 

As this disease is always attended with a fever in a 
higher or a lower degree, and is caused by too sudden a 
stoppage or diminution of perspiration and sweat, which 
are turned upon the intestines, with sometimes the addi- 
tion of infectious effluvia from others labouring under it, 
where the humours become more acrid and irritating by 
the heat of the body ; they produce an inflammation on 
the tunica villosa intestinorum, in a greater or less degree, 
which being increased by the continuance of the disease, 
extends itself to the other coats of the intestines, and too 
often ends in a mortification of them, if not timely reliev- 
ed ; as is but too evident from the symptoms which attend 
them at the last, who died of this disease, as well as from 
the inspection of their dead bodies. From whence it is 
evident, that unless a revulsion be made, and the inflam- 
mation taken off, all the boasted specificks, or famed 
restringents, how much soever extolled, are in vain, and 



24 ON THE CHANGES OF THE AIR, &c. 

too often do but hasten the death of the patient. But 
bleeding accordingly, as the strength of the patient, the 
quickness, fulness, and hardness of his pulse, and the 
height of the fever, and the other symptoms indicate, and 
that repeated as the strength of the patient and the above 
symptoms require, at proper intervals; and after giving a 
dose of ipocacuanha to cleanse the stomach, and probably 
to revulse the humours from the bowels, (12) and a dose 
of torrified rhubarb with an anodyne; giving antiphlogis- 
ticks with gentle subastringents, and moderate anodynes 
at proper distances, and diluting moderately with subas- 
tringent cooling liquids, given warm to encourage a free 
perspiration, I have always found to be the most success- 
ful method. And in some cases, where the stools contin- 
ue to be bad, and a free diaphoresis is not obtained, a dose 
or two of stibium ceratum after sufficient bleeding, Sec* 
may be given, but I have often found that giving a few 
small doses of ipocacuanha, and an anodyne after them, is 
much preferable, and has often succeeded when that much 
celebrated medicine would not. See the treatise on dys- 
entery. 

The month of November continued to be very wet, and 
much rain fell, and it was also much cooler than usual in 
other years. The quantity of rain which fell in this month, 
was equal to 12.96 cubic inches deep. The lowest the 
thermometer ever was in any morning this month, was at 
74 ; and the highest it ever was in the morning, was at 80* 
The lowest it ever was at noon was 78, and the highest at 
noon was at 83. The lowest the barometer ever was this 
month, was at 29.7, the highest at 29.9. 

We still continued to have some dysenteries, though 
much fewer then we had in the two preceding months .: 
and a few were seized with a continued slow fever of the 
synochus kind; it first came on with a moderate rigour, 

(12) Our author is happy in the choice of a word, calculated 
to express the principal indication of cure in all local or insola- 
ted diseases. It should be to " revulse" them, and thus to con- 
vey them out of the system, or to allure them to parts in which 
they are not immediately dangerous to life. 



IN THE ISLAND OF BARBADOES. 25 

which was succeeded by a great heat, a very quick pulse, 
pain all over the body, but most severe in the head, and 
in some few was attended with a catarrh and a cough, then 
came on large profuse sweats, (13) which did not relieve, 
but brought on a languor and sunk them much; their 
blood was florid and a little lax, but not dissolved. Bleed- 
ing these moderately once, or those who had more elastic 
strong fibres and a more full, hard pulse, twice, and giving 
antiphlogisticks in cooling pectorals, kept the fever mod- 
erate, and generally brought it to a crisis on the 21st day, 
when it was usually carried off by a large, warm, critical 
sweat, and in some few, by three or four loose stools, or 
in some by both. But this fever soon disappeared; and 
in general this month was more healthful than the prece- 
ding months. 

December was much more dry than the preceding 
months were, though we had a few small showers of rain, 
more than usual in this month in other years, but in ge- 
neral the days were dry. The quantity of rain which fell in 
this month, was but equal to 2.25 cubic inches deep. The 
lowest the thermometer ever was in the morning in this 
month, was at 74; and the highest it ever was in the morn- 
ing was at 78. The lowest it ever was at noon was 80, 
and the highest was at 82. The lowest the barometer was 
at 29.7, and the highest at 29.9. 

Upon the coming of this dry weather, the dysenteries 
which were frequent and epidemical all over the island in 
the three last months, now totally ceased and disappeared; 
and the inflammatory diseases also, were very few: but 
towards the latter end of the month, we had some few in- 
flammatory quinsies; and many were seized with catarrhs 
and coryzas, so that few escaped them; they all had a 
cough, hoarseness, and a great defluction of rheum on the 
nose, bronchia and lungs, coughed much, and expectora- 
ted a great quantity of tough viscid phlegm, and some 
had a fever with it; and young children were in great 
danger of being suffocated with it. 

(13) There are few fevers of the synochus type in which 
profuse sweats, in their first stage, are not hurtful. 



26 ON THE CHANGES OF THE AIR, &c. 

Bleeding those those who were plethoric and feverish, 
and pectoral attenuating medicines, which promoted a free 
expectoration, and diluting with pectoral liquids warm, 
soon relieved them: but to those children who were in 
danger of being suffocated, it was necessary to give a little 
oxymel scilliticum once or twice a day, and a little syr. 
scillitic. Often in a pectoral tea, which brought up the 
tough phlegm, and gave them immediate relief; I saw 
none that died of it, though I was told that some died of it; 
and we had but few other diseases this month. 

This year from January the 1st, 1752, to January, 1753, 
was a more than common wet year; and the whole quan- 
tity of rain which fell in this year, was equal to 67.35 cu- 
bical inches deep, which is a very great quantity of rain. 

The month of January was very dry, but moderately 
cool; the quantity of rain which fell in it, was only equal 
to 0,37 parts of a cubic inch deep. 

The lowest that the thermometer ever was in the mor- 
ning, was at 73, and the highest it ever was in the mor- 
ning this month, was at 77. The lowest it was at at noon 
w r as 78, and the highest was at 80. The lowest the baro- 
meter was at was 29.7-^, and the highest at 29.8. 

The catarrhal fever mentioned in the last month, con- 
tinued and increased, both in its being more frequent and 
more inflammatory in this, and spread all over the island; 
so that few either white or black people escaped having it 
either in a greater or less degree, and as the time advan- 
ced, it became more inflammatory. In some the inflam- 
mation fell upon the glands of the throat, and produced 
an angina inflammatoria, attended with a strong fever, a 
quick, full, strong, hard pulse, great pain in the head and 
throat, great thirst, and great heat and inflammation in 
those parts : their blood generally was highly inflamed, 
and when it stood till cold, was covered with a sizy starch 
or buff-like pellicle, and the serum of a yellowish colour, 
all which indicated plentiful bleeding, ( 14) and according- 

(14) The objections to bleeding in warm weather, in mid- 
dle climates, are fully obviated by the liberal and successful 



IX THE ISLAND OF BARBADOES. 27 

ly I found that bleeding plentifully at the beginning" of the 
disease, some cooling catharticks, and a liberal use of an- 
tiphlogisticks internally, and fomentations of the same na- 
ture externally, with emollient repelling cataplasms, with 
vinegar and crude sal. ammoniac, and sometimes letting 
them receive the fumes of vinegar through a funnel into their 
mouths and throats, and gargarisms of the same nature, 
the fever and all its symptoms were generally carried off, 
and they recovered in a few days. But when bleeding 
freely, and the liberal use of the antiphlogisticks were ne- 
glected at the beginning, they generally suppurated (but 
not without danger of suffocating the patient) in six or 
seven davs time; and when thev broke, most commonlv 
left a hard tumor in the external integuments of the throat, 
which continued a considerable time (though they gene- 
rally could breathe and swallow pretty well then) and were 
difficult to be discussed and removed afterwards. In some 
the inflammation fell first upon the throat, where it con- 
tinued a day or two, and then was translated from thence 
and fell upon the lungs and produced a violent peripneu- 
mony, and in some it fell upon the lungs at the first; in 
both it was attended with a quick, hard, and sometimes 
a pretty strong pulse, great difficulty of breathing, a cough, 
with which they expectorated a tough viscid phlegm 
with much difficulty, their thirst great, and the fever high. 
In some others this inflammation fell upon the pleura, and 
produced a pleurisy with all the symptoms of that disease. 
It was remarkable that the inflammations ran much high- 
er in all these diseases, and their blood was generally more 
inflamed and sizy in this year, than ever I observed it to be 
in this warm climate before, where the animal solids are 
generally more relaxed; and the sick in general required 
more large and oftener repeated bleedings, before the fe- 
ver and inflammation could be taken off, and the disease 



use of the lancet, by our author, in this and other diseases of 
great morbid action in a West India island. Perhaps it may be 
proper in those islands in which the medium heat is above 
that of Barbadoes. 



28 ON THE CHANGES OF THE AIR, &c. 

conquered, than ever I observed in this warm climate be- 
fore*. 

I must also here observe, that I found the crude sal. 
ammoniac to be a much more powerful attenuant, and a 
greater refrigerant or antiphlogistic when mixed with nitre, 
than any that wc have; and I found that it was more effec- 
tual in dissolving this inflammatory sizy lentor of the blood, 
than any other medicine that we have in the whole mate- 
ria medica; and though I had given it as a cooling attenuant 
for many years yet I never had such remarkable opportu- 
nities of observing its extraordinary effects in these in- 
flammatory cases, as I had this year. It cools greatly, 
and I think is more attenuating than the spir. c. c. vel 
spir. sallis ammon. vol. or their volatile salts, which stim- 
ulate and heat much at the same time. I usually give it 
when it is indicated to be given, from gr. v. to gr. xv. mix- 
ed with sal. nitre, from 3i to 9ji vel 5i in decoct, pecto- 
ral with spir. nitri dul. et spir. mindereri, and syr. e mec- 
onio to lessen the stimulus and irritation of the heat and 
fever. 

This method I found to be the most successful in the 
pleurisy, when assisted with antiphlogistic fomentations to 
relax the pained parts; and with the addition of syr. scilli- 
tic. vel oximel scillit. to assist expectoration in the perip- 
neumonic fever. And the same antiphlogistic method was 
no less successful, with the addition of cooling catharticks 
and clysters, with the beforementioned medicines and 
cataplasms in the quincey. 

Some few had an inflammatory fever, attended with a 
full, quick, hard pulse, and pain all over them, without fix- 
ing in any one part or place. These were generally relieved 



* §liiery 5. Did not this arise from the continued moist, 
wet season, in the latter part of the last year, which had 
much relaxed the solids, and diminished the perspiration in 
this warm climate ; and the sudden change from that to the 
great dryness and coolness oi the two last months, which 
had braced up the solids again and rendered them more rigid 
and elastic then they were before, without sufficiently resto- 
ring a free perspiration I 



IN THE ISLAND OF BARBADOES. 29 

by large, plentiful bleeding, and the abovementioned an* 
tiphlogictic medicines. As to the quantity of blood to 
be taken away, either in these, or in any other cases, it can- 
not be said how much is necessary, because a person for- 
med with delicate, weak, or relaxed weak fibres, cannot 
often bear the loss of nine or ten ounces of blood, so well 
as a plethoric person with strong elastic solids, can bear 
the loss of sixty or eighty ounces of blood. 

The month of February also continued to be very dry, 
though we had sometimes some small showers of rain, 
though of little importance; for the whole quantity of rain 
which fell in this month, was but equal to 1.03 inch deep. 

The lowest the thermometer ever was in the morning in 
this month, was at 74, and the highest it ever was in the 
morning this month, was at 76; the lowest it was at noon 
was at 78, and the highest at noon was at 80. The lowest 
that the barometer was, was at 29.8, and the highest at 
29.9. 

Few catarrhs appeared after the middle of the last 
month, and now they totally ceased: but the numbers in 
the above inflammatory diseases increased during this 
month, and required very large evacuations by bleeding, 
&c. before the inflammation and fever could be taken off; 
which reduced some patients pretty low. To these as 
well as to those who were naturally weak, I found it ne- 
cessary to give some cardiacs; but I soon found that the 
usual cordial waters, and cardiac medicines of the shops, 
heated and inflamed the blood too much, and increased the 
fever in this warm climate; wherefore I used the rich sweet 
wines made from mature grapes, as canary and frontigniac, 
and found them to be much better cordials in this case, 
than the hot fiery spirits of the shops are, and that they 
heated and inflamed much less; to which I sometimes added 
sp. c. c. or spir. mindereri, thus, §> decoct, pectoral. ft>i. 
vini canar. (vel frontig.) % v. elix. paragoric. §ss. spir. 
mindereri gij. syr. scillitic. giss misce. capiat aeger sal. nitri 
3ss. cum sal. amnion, crud. pur. gr. x. commixt. incochL 
tria vel quatuor hujus decoct, tertia quaq; hora. 

This revived them and encouraged the expectoration, 
abated the fever and inflammation, and answered the desi- 
red success. 



30 ON THE CHANGES OF THE AIR,&c. 

And to some I ordered vesicatories to be applied, which 
were of service now at the latter end of the disease, though 
they would have been hurtful and prejudicial towards the 
beginning of it, by increasing the fever. 

About the middle of February, a slow continued nervous 
fever seized some few patients; it usually came on 
with a slight chilliness, or a gentle rigour, and uncertain 
flushing heats, a loss of appetite, nauseas, and sometimes a 
reaching to vomit, a lassitude and listlessness, with dejec- 
tion and anxiety, a giddiness with pain in the head and 
back; an exacerbation of all these symtoms, with a low, 
quick pulse, generally towards the evening. This usually 
continued for five or six days without the patient's being 
quite cast down, or his being willing to be confined to his 
bed, or chamber, in this warm climate, in hopes of getting 
the better of it; but the rigor returning, and the fever and 
its symptoms increasing, at last obliged them to it. The 
pain in the head and giddiness increased, with a torpor or 
sense of weight and coldness in the occiput, and along the 
coronary suture accompanied with a great lassitude and 
watching, or if they did sleep, they were neither refreshed 
by it, nor sensible that they did sleep; their urine was pale 
and always without a sediment, as usual in most fevers in 
this climate; the pulse was usually low but quick, and often 
unequal or irregular; the giddiness and pain in the head 
increased much, and they were often delirious for a few 
hours and then sensible again, and it returned again in the 
same manner; and sometimes a tinnitus aurium came on, 
after which a deafness and a delirium followed; the tongue 
was sometimes dry, though often moist, but white and a lit- 
tie brown in the middle, but rarely any complaint of thirst; 
a great faintness, and sometimes a deliquium animi came 
on, especially if they sat up too long, though in the bed; 
cold, partial sweats came on, especially on the face, neck, 
and the back of the hands, and sometimes about the prae- 
cordia: some had a few loose stools, but they were so far 
from having relief from them, that the dejection and weak- 
ness vvas increased by them: the deliriums were not great 
but often returned, and sometimes where rather a confu- 
sion of action and incoherency of words, with a dozing and 



IN THE ISLAND OF BARBADOES. 31 

muttering to themselves; and they sometimes deposited 
their urine and excrements without being sensible of it. 
When the delirium increased,the extremities generally grew 
cold, and their nails livid, and the pulse became very quick, 
small, weak, and irregular; and then they swallowed their 
food with a difficult gulping, and these were soon followed 
with great tremors, twitchings and catchings, a subsultus 
tendinum,andthe delirium either soon turned to a profound 
coma, or convulsions came on, which soon snapped the 
thread of life. But on the contrary, if the sweats were 
brought to be equal all over the body, and warm, and co- 
pious, or if a plentiful spitting came on, and the pulse be- 
came fuller, softer, and freer, and vibrated w T ith more lib- 
erty, and all the symptoms changed for the better, the fever 
generally ended by a large critical, copious, warm sweat 
on the nineteenth day. 

A vomit given at the beginning of this fever, when the 
sickness, nausea or vomiting indicated it, was of singular 
service; after which, saline attenuating medicines, with 
the volatiles and gentle cardiacks were the most efficacious 
and successful, with variations pro re nata; vesicatories 
were also of great service to some: but bleeding was in 
general very prejudicial, unless where the patient was of 
a plethoric, robust constitution, and then only in the be- 
ginning of the disease, where some inflammatory symp- 
toms indicated it, which sometimes, though very rarely, 
happened, and then blood was to be taken in a very mod- 
erate quantity, but not without great caution and judg- 
ment. 

I found that the following method was both the most 
rational and the most successful also, viz. giving the spir. 
mindereri plentifully, and spir. c. c. vol. and sometimes a 
little tinct. cantharid. in warm wine-whey, made a little 
stronger than usual in other fevers ; and sometimes the 
volatile salts, and camphor, saffron, &c. or a draught of 
this nature, which I used the most frequently ; §,. sal. c. 
c. vol. $ss. succilimon. 5'iij aq. menthas simp. |iss. spin 
mindereri 5 ij. vini. crocei sj. syr. crocei. gij. misce, fiat 
haust. tenia vel quarta, quintave quaq; hora sumendus. 



32 ON THE CHANGS OF THE AIR, &c. 

To this draught I sometimes in particular cases added 
tinct. cantharid. gut. xx. and I found these of the great- 
est service, especially if the patient diluted plentifully 
with warm wine-whey, made a little stronger than 
usual. (15) 

Some few had the putrid bilious, or yellow fever in 
this month, though the season was so cool ; and that the 
now reigning epidemical, inflammatory fevers were atten- 
ded with such a great inflammatory lentor, or viscidity of 
their blood ; but it is probable that this fever might arise 
from the exercise and intemperance of those who had it 
now, as they were not many. 

The month of March was in general moderately dry, 
though we had at times some considerable showers of 
rain, so that it was not so dry as the preceding months 
were. The quantity of rain which fell in this month was 
equal to 2.21 cubical inches deep. The lowest the ther- 
mometer ever was in the morning in this month, was at 
72, and the highest it ever was in the morning was at 78; 
and the lowest it was at noon was at 78, and the highest at 
noon was at 82. The lowest the barometer was in this 
month, was at 29.8, the highest at 29.9. 

We had a few of the inflammatory fevers, and but a 
few, for they were now greatly abated ; and the slow ner- 
vous fever seemed to cease for this, and the four or five 
months following ; neither had we many chronical disea- 
ses, so that this month was more than usually health- 
ful. (16) 



(15) The editor can say nothing in favour of the tincture of 
cantharides in slow or low continued fevers from his own ex- 
perience; but from its utility in other diseases, in which stim- 
ulants are required, he has no doubt of its safety, and efficacy 
in the fever described by our author. 

(16) It is very common for a season of general health to 
follow the prevalence of epidemics. Two reasons have been 
given for it. They destroy persons debilitated by previous 
chronic diseases, or they create such new and powerful ac- 
tions as to dislodge them from the system. 



IN THE ISLAND OF BAHBADOES. S3 

April was very dry and warm, and we had very little 
rain, the whole quantity which fell in this month, was on- 
ly equal to 0.24 tenths of a cubical inch deep. 

The lowest the thermometer was in any morning was 
at 76, and the highest it ever was in the morning was at 
78 ; and the lowest it ever was at noon was 80, and the 
highest at 83. The lowest the barometer was at, was 
29.8, the highest was 29.9. 

This month, though very dry and warm, was not very 
sickly ; we had only some few inflammatory diseases, as a 
few pleurisies and peripneumonies, and some inflamma- 
tory fevers ; and also some rheumatisms of the inflamma- 
tory kind, though the last are not near so frequent here 
as they are in England ; neither are they usually in other 
years attended with so great a degree of inflammation as 
they were in this year, or as they usually are in England: 
but this year they appeared with the same symptoms as 
they usually do in England, and their blood was most 
commonly as much inflamed, and covered with a buff-like 
pellicle as it is there, and required the same method of 
treatment, viz. bleeding, cooling cathartics, and an ano- 
dyne after them (as Dr. Sydenham advises) and antiphlo- 
gistics in the intermediate days; and I found the crude 
sal. ammoniac and nitre were of great service ; and by 
this method they generally soon' recovered. 

The month of May was also very dry and warm, 
though we had some rain towards the latter end of it. 
The whole quantity which fell in this month was onlyzr 
1.31 cubic inch deep. The lowest the thermometer ever 
was in the morning, was at 77, and the highest it was at 
in the morning, was at 81 ; the lowest it was at noon, was 
at 80, and the highest at 86. The lowest the barometer 
was 29.84, the highest was at 29. 9^. 

The diseases we had this month were of the inflamma- 
tory kind, as in the last ; a few pleurisies and peripneu- 
monies, and some had tumors about the fauces, neck, or 
in other glandulous parts, which suppurated slowly and 
with difficulty, and some of them left hard tumors in 
those parts for a considerable time after, as observed be- 
fore : and the humors seemed now again to have a great* 

E 



U OK THE CHANGES OF THE AIR, &c. 

er tendency towards the head and breast, as they had 
then; and we had some few apoplexies and palsies. 

June was very warm and mostly dry, though we had con- 
siderable great showers of rain in some days, but the in- 
termediate days were very warm and dry. The quantity 
of rain which fell in this month, was equal to 2.44 cubi- 
cal inches deep. The lowest the thermometer was any 
morning was at 77, and the highest it ever was in the 
morning was at 80; the lowest at noon was at 82, and the 
highest at 86. The lowest the barometer was at 29.8^, the 
highest was at 29.9. 

Though this month was very warm, yet it was in gen- 
eral pretty healthful, for we had few sick, except a few 
who had some of the above mentioned inflammatory fe- 
vers ; and these were much less violent, and more easily 
relieved by moderate bleeding and the above mentioned 
antiphlogistic method, than in the preceding months. 

But towards the latter end of the month, some had a 
diarrhoea febrilis, and a few had a dysentery, but neither 
of them were very bad, nor were they difficult to cure. 
Some had the dry belly-ache, which now was attended with 
some degree of inflammation, and with some inflammatory 
symptoms, which are not usual in that disease, nor did I 
ever meet with it before or since. This rendered its 
cure a little more difficult, and less expeditious than the 
cure of that disease now usually is; for some in this re- 
quired bleeding and the use of antiphlogistics, to be 
given with those medicines which are known to relieve, 
and take off that painful disease at other times; and their 
blood was more or less sizy in this, though I rarely or 
never found it so in the true pictonic cholic before 
now. (16) 

Several, both strangers and natives, were seized with 
the putrid bilious fever, in which I found the method of 
treating it (hereafter mentioned) very successful. See p. 
1. part II. 

(16) The dry belly-ache mentioned in this place, was com- 
plicated with the bilious colic. This is obvious from its being 
accompanied with two other intestinal states of fever, and 
from the remedies it recuired to cure it. 



IN THE ISLAND OF BARBADOES. 35 

Some were seized with a rigor which did not continue 
long, but was succeeded by a brisk hot fever which usu- 
ally continued three or four days, when a tumor began to 
rise usually either in the parotid, subaxillary, or inguinal 
glands, or in some other parts of the body ; upon the ap- 
pearance of which the fever began to abate, and gradually 
went off as the suppuration of the gland advanced, with- 
out any malignant or other bad symptoms, and they soon 
recovered. 

In July we had a good deal of rain, often with thunder 
and lightning, though the intermediate days were hot and 
dry. The quantity of rain which fell was equal to 6.67 
cubic inches deep. The lowest the thermometer was in 
the morning was 78, the highest 80 ; the lowest it was at 
noon was at 80, the highest was at 86. The lowest the 
barometer was at 29.9, the highest was at 29. 9i. 

After the falling of this rain, the number of the sick 
was considerably increased ; pleurisies, peripneu monies, 
and inflammatory fevers were more frequent, especially 
the last. Dysenteries also now became frequent, as usual 
after the falling of the rain. And the slow continued fever 
now returned again, with much the same symptoms as it 
had in February, and was cured by the same method and 
medicines as then, only blistering more freely or frequent- 
ly, as the sick were generally more sunk and their pulse 
usually lower, was necessary, and was of very great service: 
but as the fever then usually w T ent off by a manifest crisis, 
by sweating or stools on the nineteenth day, it now grad- 
ually declined after the twentieth day, and went off with- 
out any manifest crisis.(17) 

Several were seized with apoplexies and palsies this 
month, more than I have ever seen here in any one year 
before. 

The pertussis or hooping cough also now seized many 
children in this town and island. This is a disease, which 
from all the observations that I have been able to make, 

(17) It is no uncommon thing for this form of fevers to go 
off without any critical evacuation, especially where the ope- 
rations of nature have been disturbed or prevented by artificial 
remedies. 



36 ON THE CHANGES OF THE AIR, &c. 

seems to be equally as infectious to children, as either the 
small-pox or measles are ; though I think it has not been 
mentioned as such, by any one yet that I have seen : for 
whenever it comes into a family or town, I have observed 
that it generally infects and seizes all the children in the 
town who have not had it before, as the small-pox and 
measles usually do : neither have I ever observed, or 
heard from others, that they have known any person to 
have it twice ; therefore does it not arise from some infec- 
tious miasmata as they do ? and is so far analogous to 
them ; as also in this that it chiefly affects children, rarely 
adults as they do ; though I have known several ancient 
people both here and in England to have it, but they all 
said that they never had it before. And as this disease has 
not been known to be in this island for many years past, 
neither could I find by the strictest enquiry that I could 
make, that any child or elder person did bring it hither ; 
now, must we not conclude that it is a disease which pro- 
ceeds from some peculiar disposition in the air to gene- 
rate its infection or miasma, or that they can be carried 
in the air from some other place to this great distance, 
which being taken with the saliva or otherwise into the 
circulating fluids, as other infectious diseases are ; it there 
generates a peculiar viscidity in the serous, lymphatic, 
or yet finer fluids, and particularly in those of the bron- 
chia and lungs, which at the same time do greatly irritate 
those sensible nervous parts, so as to produce that con- 
vulsive cough, and convulsive spasms which usually at- 
tend it, which again are increased by the viscidity of the 
finer fluids. 

This being the cause, and these the effects of it, the 
intentions of cure must be to lessen the quantity and at- 
tenuate the viscidity of the fluids, and abate the stimulus* 
Wherefore bleeding such children as are of a sanguine 
plethoric constitution, and keeping the body moderately 
open, are necessary, and to attenuate the viscid fluids as 
much as we can ; for which purpose I have found some- 
thing of the following nature, with variations pro re nata ? 
the most effectual. 



IN THE ISLAND OF BARBADOES. 37 

§>. milleped. viv. bene lot. §ss. contund. in mort. vitreo. 
et superaffund. infusionis rad. glycyrrhiz, gviii. probe 
conterent. deinde cola, colaturse adde aq. sem. fceniculi 
Jij. aq.nuc. moscat. spir. nitri dul. ana §ss. tinct. can- 
tharid. 5ij. syr. e mecon. §ss. vel §i. misce, exhibe cochl. 
unum subinde urgente tusse. auget. dos. pro ratione 
cetatis oegri. 

And if die symptoms increase and the patient's pulse 
will permit, more blood may be taken away ; but if the 
pulse be small and low, a vesicatory may be applied and 
kept open, or the quantity of the tinct. cantharid. increas- 
ed, if the symptoms of a stranguary do not forbid it : and 
if convulsion fits come on, I usually give musk with a 
little syr. e mecon. or elix. paragoric ; but the first sel- 
dom fails to render the disease more moderate, and in 
time takes it off. (18) 

The month of August was more dry and warm than the 
last month, though we had some wet days towards the 
latter end of it. The quantity of rain which fell in this 
month was equal to 3.47 cubic inches deep. The lowest 
the thermometer was in the morning was 79, and the 
highest was 82 ; the lowest it was at noon was at 83, and 
the highest was at 86. The lowest the barometer was, at 
29.9, the highest at 29.9. 

The inflammatory diseases which reigned in the prece- 
ding months continued, and rather increased in this; es- 
pecially pleurisies, peripneumonies, pleuro-peripneumo- 
nies, and the inflammatory fevers, and dysenteries became 
more frequent; and their blood in all these was generally 
full as sizy, or rather more so, than in the last year. The 
hooping cough also continued to affect children, and we 

(18) The hooping cough is often relieved by bleeding, es- 
pecially when it is combined with catarrhal symptoms. There 
are many simple, and some more powerful remedies for the 
mitigation of this disease, than the one mentioned by our au- 
thor, particularly a solution of the vegetable alkali in water, 
the tincture of assafcetida, the sugar of lead, occasional 
emetics, and purges of rhubarb and calomel, and small doses 
of laudanum. 



58 O^ THE CHANGES OF THE AIR, Sic. 

had a few apoplexies and palsies : and some had the slow 
continued fever, as in the last months; in which I found 
the acetum camphoratum, spiritus mindereri, vel haustus e 
volatilibus fuller ii, or the learned Dr. Huxham's draught 
of sal. c. c. et succus limon. as before, and vesicatories, 
were the most efficacious medicines, and were of the great- 
est service* 

A cholera morbus also seized several, especially chil- 
dren ; in which I found that giving rad. ipocacuanh, gr. 
i. vel gr. ij. vel vini ipocacuanh. gut. xx. vel xxx. in a lit- 
tle green tea, or chicken water, to encourage the vomit- 
ing; and tinct. thebaic, a gut. v. ad x. and more to adults, 
after it ; and a small dose of rad. rhei with an anodvne a 
few hours after that ; and then a saline julep with an ano- 
dyne generally took it quite off: but if the vomiting still 
continued, a fotus ex fol. menthse, theriac. androm. cum 
paul. vini rubri applied to the region of the stomach, with 
the use of the saline julep, constantly took it off, and they 
soon recovered. 

We had much rain in September, though we had some 
intermediate days which were dry and very warm, as this 
is usually the hottest month in the year. The quantity of 
rain which fell in this month was equal to 8.77 cubic in- 
ches deep. The lowest the thermometer was in the mor- 
ning was at 77, and the highest was at 82 ; the lowest it 
was at noon was at 80, and the highest was at 86. The 
lowest the barometer was at 29.8, and the highest was at 
29.9. 

The epidemical diseases of this month were the same 
as in the last months; and notwithstanding that we had so 
much rain in this month, yet the dysentery was not alto- 
gether so frequent as it was in the last month: but the pe- 
ripneumonies, and pleuro-peripneu monies, were usually 
attended with more pain in the head, the fever higher, and 
the pulse usually more tense and hard, and their blood 
was much inflamed and covered with a thick starch or 
buff-like pellicle. 

The slow, continued fever was also more frequent, but 
their blood never was inflamed, nor ever had the least ap- 
pearance of a siziness in it. 



IN THE ISLAND OF BARBADOES. 39 

October also continued to be wet, more than usual in 
that month, though we had several interposed days that 
were dry and very warm. The quantity of rain which fell in 
this month was equal to 8.17 cubic inches deep. The lowest 
the thermometer was at in the mornings was 76, and the 
highest w T as at 80 ; the lowest it was at noon was at 80, 
and the highest at noon was at 86. The lowest the barom- 
eter ever was, was at 29.6, and the highest this month 
was at 29.8. I never saw the barometer thus low as it 
was on the first of this month, at 29.6, and that day we 
had a storm, or very high wind, and great showers of rain. 

The inflammatory diseases, which reigned in the prece- 
ding months, were much less frequent in this ; but the 
dysentery was both more frequent and more violent in its 
symptoms, and more difficult to be cured. The hooping- 
cough was also more frequent among children ; and a few 
were seized with the slow continued fever, as in the last 
month. 

Likewise some had the putrid, bilious, or yellow fever, 
but it was either more mild and its symptoms less violent 
than it visually is, or it was rendered so by the method of 
treating it; which see, part II. For though its symptoms 
at the first were as usual, yet they soon became more 
moderate by being thus treated ; and all I did see, recov- 
ered. 

November was very dry, and warmer than usual in 
other years. The quantity of rain which fell this month 
was only equal to 1.33 cubic inches deep. The lowest the 
thermometer was in the mornings, was 75, the highest 
was at 78 ; the lowest it was at noon was at 80, and the 
highest at noon was 86. The lowest the barometer was, 
is 29.8, and the highest 29.8. It did not alter in this 
month but was always the same. 

The dysentery which was very frequent in the two last 
months, upon the season being more warm and dry, be- 
came much less so, and towards the latter end of the 
month it totally ceased : but the inflammatory diseases, 
especially pleurisies, peripneumonies, opthalmies, and 
some quinsies, still continued, and now were attended 
with more pain in the head than usual; for the humors 
now again had a greater disposition or tendency towards 



40 ON THE CHANGES OF THE AIR, &c. 

the head, than usual at other times. The hooping-cough 
also still continued among the children; and some few 
had the putrid, bilious, or yellow fever. (19) 

December also continued to be very dry, and consider- 
ably warmer than usual in this month ; though we had a 
few small showers ill some days. The quantity of rain 
which fell this month, was equal to 2.11 cubic inches 
deep. The lowest that the thermometer was in the mor- 
nings was at 73, the highest at 78 ; the lowest it was at 
noon was at 80, and the highest at noon was at 82. The 
lowest the barometer was at was 29.8, and the highest 
was at 29. Si. 

The hooping-cough, and the above mentioned inflam- 
matory diseases, almost totally ceased and disappeared in 
this month also. 

Some few were seized with pain in their heads, and 
swellings about the fauces, and the humors still contin- 
ued to have a more than usual tendency towards the head 
and the superior parts of the breast, in this as well as 
in the last months; but in general both this and the 
last month were more than usually healthful: for the only 
disease which could properly be called epidemical was 
an inflammation of the mediastinum, which most common- 
ly chiefly seized the superior part of it above the pericar- 
dium, and only seized the negroes, and few or any white 
people. It first came on with a cold rigor and tremor, 
which continued one, and sometimes two hours, and 
was then succeeded by a hot fever, with great heat and 
acute pain in the upper part of the breast, with darting 
pains from the superior part of the sternum, through 
the upper part of the mediastinum to the spine; great 
pain in the head, with a quick, hard, full pulse, a laborious, 
difficult, quick breathing: some had a cough and a great 
anxiety at their breast, others had not; those who had, 

(19) Here we see a number of diseases of different charac- 
ters appearing at the same time, but without so much superi- 
ority of force in any one of them^ as to banish the others. 
Their variety probably depended upon a difference in the pre- 
disposition of the subjects of them. 



LN THE ISLAND OF BARBADOES. 41 

generally had a very quick, small, hard pulse, which 
usually after bleeding became more full, a dry tongue 
and great thirst, and as the disease advanced they gen- 
erally grew delirious. The heat about the praecordia and 
upper part of the chest, as also in the head, was very great; 
they expectorated little; their urine was high coloured with- 
out a sediment ; their blood was florid and red on the 
first day, but sizy on the second and after. Bleeding 
plentifully at the first beginning of the disease, and re- 
peating it if the symptoms indicated it, and a liberal use 
of the antiphlogistic medicines, with a cooling diluting 
regimen, and the use of a cooling emollient antiphlogistic 
fomentations to the breast, most commonly relieved them, 
and carried it off in four or five days time. But if bleed- 
ing copiously at the first, and the above antiphlogistic 
method was not timely used, they usually became deliri- 
ous on the third day, and their pulse became exceed- 
ing quick, small and irregular, and their extreme parts 
cold, and they died. 

In some it did not fall upon the breast, but upon the 
head and brain, and first one eye swelled as if from a 
stroke or contusion, and then the other eye in the same 
manner, the fever great, and they soon after became de- 
lirious, which increased and was a certain sign that the 
brain or its meninges were inflamed as well as the eyes; 
soon after this the pulse became quick, small and irregu- 
lar, and their extreme parts cold; and most of them who 
were seized thus died. 

The whole quantity of rain which fell in this year 
1753, was equal to 38.12, cubical inches deep. 

The month of January was cool and pleasant, but very 
dry till the 21st day, on which and the three following 
days we had much rain, and then it was dry to the end 
of the month. The quantity of rain which fell in this 
month was equal to 5.63 cubic inches deep. The lowest 
the thermometer was any morning was 72, and the 
highest was 76; the lowest it was at noon w r as at 76, and 
the highest at 80. The lowest the barometer was at 29.74-, 
and the highest at 29.9. 



42 ON THE CHANGES OF THE AIR, &c. 

The slow, continued, nervous fever still continued in 
some parts of the island; and some negroes had the in- 
flammatory fever described in the last month: and we had 
a few quinseys of the inflammatory kind, but upon the 
falling of the rain in the latter end of the month, both 
these last soon after ceased and disappeard. But the hoop- 
ing-cough still appeared in the remote parts of the island, 
and also the small-pox, but they generally were of a be- 
nign, distinct kind. 

February was very dry and moderately cool, and we 
had no rain except on the 10th day; the whole quantity 
which fell this month was only equal to 0.89 parts of a 
cubical inch deep. The lowest the thermometer was any 
morning, was at 72, the highest was at 76; the lowest it was 
at noon was at 78, and highest was at 82. The lowest 
the barometer, was at 29. 7i, and the highest was at 29.9. 

The slow nervous fever still continued in some parts of 
the island, and the hooping-cough also in some remote 
parts of it; but the small-pox now totally ceased. We 
had some few inflammatory fevers, and but few, and they 
totally disappeared about the middle of this month, and 
it was pretty healthful. 

March was also dry till near the latter end of the month, 
when we had a considerable quantity of rain; it was also 
moderately cool. The quantity of rain which fell was 
only equal to 3.53 cubic inches deep. The lowest the 
thermometer was in the morning, was at 73, the highest 
was 77; the lowest it was at noon was 78, and the highest 
at noon was 82. The lowest the barometer was at 29.8, 
and the highest at 22.9. 

I cannot say that we had any diseases that were epidemi- 
cal in this month, but the slow nervous fever, which now 
was much more frequent than it was in any of the preced- 
ing months: its symptoms were much the same as before 
described, except that the loose stools, or slight diarrhoea, 
which usually came on towards the beginning of the dis- 
ease, were now less frquent; and the delirium, tremors, 
startings, catchings, and the subsultus tendinum, were 



IN THE ISLAND OF BARBADOES. 43 

both greater and more frequent than they were before.* 
And the fever now put on and appeared in this warm 
climate, with all the same symptoms as it usually 
does in England; and as they are accurately described by 
that learned and able physician Dr. Huxham in the cooler 
climate of Plymouth, which therefore I need not here re- 
peat. I shall observe, that this fever now came constant- 
ly and regularly to a crisis on the nineteenth day, unless it 
was injuriously wrong treated; neither would a small 
matter divert it from coming to its crisis on that day: for 
I saw a worthy and ingenious gentleman, who on the six- 
teenth day of the fever lost above two quarts of blood in 
half an hour's time, by the bursting of one of the internal 
hemorrhoid veins, which sunk him as low and as near 
death as possible; but the haemorrhage being instantly 
stopped by stypticks, and some cardiac and volatile medi- 
cines given immediately after, and suitable cordial nour- 
ishment; his pulse, which was scarce perceptible for some 
considerable time after it, did so rise on that and the next 
day, that on the eighteenth day it was more full than ever 
before, though he was of a slender, thin, dry constitution; 
and on the nineteenth day his fever came to a regular 
and complete crisis, and he perfectly recovered. (20) I 
also saw another patient who lost as much blood, or more, 
in the same manner; but his hemorrhage caused the 
coming on of the crisis to be deferred to the twenty - 



* §>iiery 6. Were not some of the infectious miasmata, 
or of the morbid matter, discharged and carried off by those 
loose stools, which rendered the above symptoms more mod- 
erate and milder after? and when nature did not so carry the 
morbid matter off, were not those symptoms more violent? 
and did not nature thus shew us the way we ought to fol- 
low and assist her? at least I thought so; and found that 
such as I saw in time to give a dose of ipocacuanha and a 
little rhubarb after, I generally found that the symptoms were 
more moderate alter. 

(20) We behold in the history of this case a striking illus- 
tration of the disposition of fevers to run their course, in spite; 
of the power of medicine. Sir John Pringle mentions a case 
in which profuse sweats were equally ineffectual in arresting 
the natural and usual critical dav of a chronic fever. 



44 ON THE CHANGES OF THE AIR,&c. 

sixth day, and yet he recovered; but the crisis in all the 
others constantly came regularly on, on the nineteenth 
dav. 

I found that giving an emetic at the beginning of the 
disease, and a dose of rhubarb after it, or in some cases 
only the latter; and then giving spir. mindereri 3ss in any 
fit simple water with a little vini crocei, or acetum cam- 
phoratum to some patients, or saline draughts with vola- 
tiles, or Dr. Huxham's saline draught to others, every 
three, four, or six hours, as the fever w 7 as higher or lower, 
or sunk too low, and diluting plentifully with warm wine- 
whey, sometimes made pretty strong of the wine, especi- 
ally when they were weak and low, were of the greatest 
service; as also were vesicatories: so likewise were musk, 
camphor, and tinct. of cantharides, when the convulsive 
spasms were great; as these attenuated the viscidity of the 
lymph and finer fluids, without too much inflaming the 
blood; whereas the rad. serpentar. virg. confect. cardiac, 
and such hot medicines, heated and inflamed more, with- 
out attenuating the fluids so much, as I observed; which 
confirms die opinion of the learned Dr. Huxham, that the 
cause and seat of this disease is chiefly in the lymph and 
liner fluids, in which it produces a viscidity and inaptitude 
to motion. (21) 

This slow nervous fever was certainly infectious, for I 
observed that many of those who visited, and most of 
them that attended the sick in this fever, were infected 
by it and got the disease, and especially those who con- 
stantly attended them, and performed the necessary offi- 
ces for the sick. 

The month of April was also dry in general, though 
we had some showers of rain sometimes; but from the 
middle of it to its latter end, it was more warm than usu- 
al in other years. The quantity of rain which fell in this 

(21) The typhus fever when of long duration often generates 
a matter that produces a fever. It has been called the u con- 
tagion of excretion" to distinguish it from the scereted con-, 
tagions of the measles and small-pox. 



IN THE ISLAND OF BARBADOES. AS 

month was equal to 4.22 cubic inches deep. The lowest 
the thermometer was in the mornings, was 76, the high- 
est 80; the lowest it was at noon was at 80, and the high- 
est at noon was 85. The lowest the barometer, was at 
29.8, and continued the same all the month. 

The slow nervous fever still continued in some remote 
parts of the island, though they were but few that had it. 
We also had a few pleuro-peripneumonies, but the inflam- 
mation that attended it was not very great, neither was it 
commonly very dangerous. 

Some were seized with a violent pain and inflammation 
at the scrobiculum cordis, which extended to the stomach, 
attended with sicknessand vomiting; a quick pulse, though 
in some it was small and oppressed, though commonly- 
hard, and accompanied with cold clammy sweats, and some 
had a few loose stools with it at the beginning; it differed 
from a cholera morbus in most of its symptoms, though 
it had some of them, and was really an inflammation on those 
parts, which nature attempted to relieve by the vom- 
iting and stools, but could not: the pulse being low, though 
quick, and the extremities cold, it deterred many from bleed- 
ing them; yet they could not be relieved, nor the pain re- 
moved without it: but upon bleeding, the pain abated, 
and the pulse became more full, and softer, and the cold- 
ness on the extremities went off, so that it might be repeat- 
ed where it was necessary; (22) and by the use of fomen- 
tations to the pained parts, and giving antiphlogistics 
liberally, and some volatiles, they were generally pretty- 
soon restored to health. This disease came in with the 
hot weather, and did not continue long.* The hooping- 
cough still continued in some remote parts of the island. 

(22) Similar good effects have often been observed from 
bleeding in the same state of the system in the bilious fevers 
of the United States. Let the young practitioner be encour- 
aged in the use of this practice by the respectable authority 
of our author in its favour. 

* §>uery 7. As the nervous fever was then epidemical, were 
not some of its infectious miasmata received by the sick at 
the §ame time as they were seized with the inflammation, 



46 ON THE CHANGES OF THE AIR, &c 

The beginning of May was very warm and dry, but 
from the 8th day to the end of the month we had a great 
deal of rain, more than the most ancient people could 
remember to have seen at this time of the year. The 
quantity which did fall was equal to 14.65 cubic 
inches deep. The lowest the thermometer was in the 
mornings, was at 77, the highest at 80; the lowest it 
ever was at noon, was at 78, the highest at noon was 
at 86. The lowest the barometer, was at 29.74-, the high- 
est was at 29.9. 

So much rain falling rendered the air more cool and 
temperate, and the season more healthful; and we had 
no diseases which could be properly called epidemical, 
except a few pleurisies of the nothous kind, and an 
uncommon kind of jaundice which seized several chil- 
dren.* The first was most commonly carried off by 
bleeding once or twice, a cooling purge or two, and anti- 
phlogistics with volatiles after. 

The jaundice which seized children, chiefly from three 
to seven or eight years of age, usually came on with an 
indisposition to play, and an indolence to motion, a loss 
of appetite, white costive stools, a small dull pain at the 
region of the liver ; some were a little feverish, but none 
had any symptoms of an inflammation of the liver, or of 
the biliary ducts ; others had no feverish heat, but they 
all had a considerable degree of yellowness in their skin and 
their eyes. (23) 



and produced that small, low pulse, and cold clammy sweats, 
which are symptoms which do not usually attend an inflamma- 
tion, at least the beginning of it ? As this certainly was an inflam- 
mation both from its symptoms, and from some that I saw who 
had been treated with hot medicines, and died of it with all 
the marks of a mortification on those parts. 

* §>uery 8. As this jaundice seized several children in the 
same town, and sometimes in the same house, at, or near the 
same time, and some time after ceased or disappeared; may we 
not conclude it was epidemical? 

(23) We see in the history of this jaundice or a moderate 
grade of bilious fever among children, an illustration of that 
law of epidemics which disposes certain diseases to affect 
children without attacking adults. 



IN THE ISLAND OF BARBADOES. 47 

This uncommon jaundice was generally carried off by 
gentle opening cathartics, and a few saponaceous medi- 
cines, with a few gentle, easy stomachics to restore the 
appetite after. 

After these rains the nervous fever ceased in the town 
and near it. 

The month of June was uncommonly wet, and more 
rain fell than any person living here could remember to 
have ever seen at this time, or any other time of the year; 
for we had several great floods which did considerable 
damage to several houses. The quantity of rain which fell 
this month was equal to 19.78 cubic inches deep. The low- 
est the thermometer was in the morning, was at 76, the 
highest at 80 ; the lowest it ever was at noon, was at 78, 
and the highest at noon was 85. The lowest the barome- 
ter, was at 29.8, and the highest was at 29.9. 

We had much thunder and lightning with these great 
rains. 

So much rain falling rendered the air cooler and moist- 
er than usual, and it was also pretty healthful ; for we had 
no diseases which could be said to be epidemical, except a 
few pleurisies, some of them of the nothous kind, and some 
pleuro-peripneumonies, and some few who had an inflam- 
mation of the stomach, and of the intestines ; but these 
were seldom inflamed in any great degree, nor the fever 
violent in any of them, therefore they were generally pret- 
ty soon relieved by bleeding, and the use of antiphlogis- 
tics internally and externally, and recovered pretty soon. 
The hooping-cough still continued among children in the 
north-west part of the island, and some adults had it there 
also, who had not had it before. 

In July we had frequent showers of rain, though not 
near so much as we had in the last month, nor so much 
thunder and lightning, though we had some about the 
middle of the month. The quantity of rain which fell in 
this month, was equal to 7.52 cubical inches deep. The 
lowest the thermometer was in the morning, was 76, the 
highest was at 80 ; the lowest it was at noon was at 81, 
and the highest at noon was 86. The lowest the barom- 
eter, was at 29.8, the highest was at 29.9, 



48 ON THE CHANGES OF THE AIR, &c; 

This month was also much cooler than usual in other 
years, and also more healthful ; though we had a few pleu- 
risies and peripneumonies, and some diarrhoeas and dy- 
senteries : but these were but few, and were very rarely 
attended either with so great a degree of inflammation or 
malignity, as they usually are in a more warm, wet season, 
coming upon a long, hot, dry season. (24) Several were 
seized with a hard, dry cough, they expectorated little, 
and that was clear, tough, viscid, and unconnected, and was 
brought up with violent coughing and difficulty.* Nei- 
ther emollient pectorals, oily mixtures, nor yet opiates 
were of much service : but volatiles, as sal. c. c. vol. flor. 
benzoin, &c. mixed with a little theriac. adrom. given 
two or three times a day, soon relieved them, and repeating 
it two or three days, took it quite off. 

Some few had the slow nervous fever in the remote 
parts of the island, and the hooping-cough still continued 
among the children in those parts. 

We had frequent showers of rain in august, and some- 
times thunder and lightning with great showers, intermix- 
ed with calm, hot days, so that it might be called a moist, 
hot season. The quantity of rain which fell in this month, 
was only equal to 4.69 cubic inches deep. The lowest 
the thermometer was in the morning, was 77, the highest 
was at 80 ; the lowest it was at noon was at 81, and the 
highest at noon was at 85. The lowest the barometer, 
was at 29.8, and the highest was at 29.9. 

This moist, warm season continuing, diarrhoeas and 
dysenteries were more frequent, especially among the ne- 
groes ; though some white people had it also, but it was 
more malignant than in most other years. 



(24) The variety of diseases, enumerated by our author, 
during this month,' and all originating in the same causes, 
must be ascribed, like the diseases in November 1753, to va- 
riety ot predisposition in the persons who were the subjects of 
them. 

* £>uerif 9. Did not this uncommon cough arise from that 
unusual degree of moisture and coolness of the air, at this 
time of the year, introducing such a degree of viscidity into 



IN THE ISLA^T) OF BARBADOES. 49 

We had also some few pleurisies and peripneumonies ; 
and several were seized with an inflammation of the pelvis 
and peritoneum about the lower region of the belly, which 
often extended to the neck of the bladder, attended with 
acute pain in those parts, and a difficulty of making water, 
and sometimes with great pain in going to stool : their 
pulse was quick and hard, though generally small, and 
sometimes attended with a coldness and cold sweats on 
the extreme parts,* which often deterred the apothecaries 
from bleeding them : though it was a true inflammation 
on those parts, and upon bleeding them the pain abated, 
and the pulse became more full, and the heat was equally 
diffused all over the body. By bleeding, fomentations to 
the pained parts, cooling emollient clysters, and a free use 
of antiphlogistics, they generally soon recovered. (25) 
Here the acuteness of the pain was the principal indication 
for bleeding, and its causing the pulse to rise, the cold 
sweats to go off, and its success, confirmed its being an 
inflammation of those parts, and this practice to be right. 

Some few patients were seized with a wkx&i or a con ~ 
tinued remitting fever, which here usually came to a cri- 
sis on the fourteenth day, but in some it did not come to 
its crisis till the seventeenth or nineteenth day, and then 
went off: but it never came to intermit regularly here in 
any, as it frequently uses to do in England. 

The slow nervous fever still continued in the north-east 
parts of the island, with the same symptoms, and came to 



the circulating fluids, and falling upon the bronchia and lungs, 
or was that viscidity produced by the same cause which pro- 
duced it in the hooping-cough, which was then epidemical? 

^ Query 10. Did not this continued moist, warm state of the 
air, so relax the solids as to bring on this small pulse and cold 
sweats, &c. in this inflammation, as also in that of the scrobi- 
culum cordis, or stomach and diaphragm before mentioned, 
with the same symptoms ? which usually do not attend an 
inflammation at its beginning, as in these, which were both in- 
flammations. 

(25) See here! a striking proof of the safety and advantages 
ef bleeding in a depressed state of the system, and of being 
guided by " acuteness of pain" instead of a full or tense pulse* 

G 



50 ON THE CHANGES OP THE AIR, &c. 

its crisis on the nineteenth day, when in and near the town 
in the winter or cooler months; but it has not appeared in, 
or near the town, since the month of May. 

We had frequent showers of rain, and sometimes thun- 
der and lightning, and much rain in the month of Septem- 
ber : though the intervening days were generally very 
warm, and either calm, or we had small variable winds, 
mostly from some of the southern points, which are usu- 
ally hot. The quantity of rain which fell this month, was 
equal to 6.10 cubic inches deep. The lowest the thermom- 
eter was in the morning, was 77, the highest was 80 ; the 
lowest it was at noon was at 81, and the highest at noon 
was 85. The lowest the barometer, was at 29.7, and the 
highest at 29.9. 

The weather continuing to be moist and warm, dysen- 
teries were more frequent, especially among the white 
people ; and were now attended with a greater degree of 
inflammation than they were in the last months. But 
bleeding once or twice, an emetic, and toasted rhubarb 
with an opiate after, and antiphlogistics with gentle re- 
stringents and opiates, to abate the pain and restrain the 
violence of the flux, till the inflammation was taken off, 
were generally successful. The inflammation of the 
pelvis and peritoneum, also continued to seize several in 
this month, as well as in the last; and I observed that the 
humors had an unusual tendency and afflux towards the 
lower parts of the belly, in these two months, as they had 
towards the head and breast, or the upper parts of the bo- 
dy, in the preceding hot and dry months.* (26) 

* Suiter ij 11. does not the continued driness of the season 
brace up the solids, and dispose them to inflammations; and the 
continued heat of the sun affect the head and upper parts of 
the body, so as to cause a greater afflux of the humors to 
those parts, in long continued dry, hot seasons? and do not 
the continued moist, warm seasons, relax the solids, especially 
those of the abdomen, which are naturally more moist, and 
so cause a greater afflux of the humors to them in such sea- 
sons, to which a diminution of perspiration in such seasons 
may contribute? 

(26) The pelvis is one of many other parts of the body to 
which diseased excitement is disposed to ramble beyond the 



IN THE ISLAND OF BARBADOES. 51 

Arthritics also suffered much in this month, by the 
gout appearing with anomolous symptoms, and often at- 
tacking the bowels, or falling upon the pelvis and the neck 
of the bladder: (27) but they were generally relieved by 
bathing their feet in a decoction of piemento leaves, or 
other warm stimulating aromatics, and applying stimu- 
lating foenigmi to the soles of the feet, or vesicatories to 
the remote parts which it used to attack when regular; 
and giving some aromatics with light chalybeats and vol- 
atiles, by which methods it was generally brought to be 
regular, and was carried off as usual. 

We had a few pleurisies, quinsevs, and ophthalmies, 
and but few; and these were generally of a mild, benign 
kind, and pretty easily cured. 

The slow nervous fever which had continued eighteen 
months in this island, in one part or other of it, now to- 
tally disappeared, and left the island, and I think has not 
been seen in it since; though some have been pleased to 
call some other fevers by that name. 

October was this year much hotter than usual in other 
years, and also very dry, except that on the 18th, 19th, and 
31st days, we had much thunder and lightning, and a con- 
siderable deal of rain: so that the quantity of rain which 
fell in this month, though mostly dry, was equal to 4.07 
cubic inches deep. The lowest the thermometer was in 
the morning, was at 76, the highest was at 82; the lowest 
it was at noon was at 82, and the highest at 86, and 
mostly at 85 or 86. The lowest the barometer, was at 
29.7/and the highest was at 29.9. 

This month being very dry and warm, dysenteries be- 
came much less frequent, and more mild and moderate; 

limits of nosology. It is not more difficult to cure it upon this 
account. The remedies should be the same for this purpose 
as for disease in its more common seats. 

(27) Our author confirms a remark made by all physicians 
of accurate observation, respecting the gout. It seldom fails of 
doing homage to reigning epidemics by assuming some of their 
symptoms: it is moreover often excited by them. 



52 ON THE CHANGES OF THE AIR, &c. 

and the inflammatory fevers fewer and much less violent 
also;* and it was in general more healthful. 

A febris ephemera seized some few, with a cold rigor, 
which usually continued about an hour, and was then suc- 
ceeded by a brisk, hot fever, a quick, full pulse, seldom 
hard, the heat great, which usually continued about four- 
teen or sixteen hours, when a general, copious, warm, crit- 
ical sweat came on, and carried the fever quite oft in the 
space of twenty-four hours time, as a true simple ephe- 
mera does. 

In the month of November we had frequent showers of 
rain, and it was much cooler in general than the months 
last past. The quantity of rain which fell in this month 
was equal to 4.66 cubic inches deep. The lowest the ther- 
mometer was in the morning, was at 76, and the highest 
was at 80; the lowest it was at noon, was at 79, and the 
highest at noon was at 84. The lowest the barometer, was 
29.7, and the highest was at 29.8. 

This month also continued to be pretty healthful; but 
towards the latter end of it we had a few diarrhoeas, and 
some dysenteries, mostly among the negroes, and a few 
inflammatory fevers; and we had no diseases but these, 
which could be said to be epidemical. 

The month of December is usually, in other years, a dry , 
month, but this was very wet, for we had rain almost eve- 
ry day more or less, and some days much rain, which 
rendered it also more cool than usual. The quantity of 
rain which fell this month was equal to 11.27 cubic inches 
deep. The lowest the thermometer was in the morning, 
was at 75, the highest was at 78; the lowest it was at 
noon was at 77, the highest at noon was at 82. The low- 
est the barometer, was at 29.6-*, the highest was at 29.8. 

*$%nery 12. Did not this proceed from the long continuance 
of the moist, warm season in the preceding months, by which 
the animal solids were relaxed, and rendered less fit, or less 
liable to produce inflammatory diseases? And did not the 
coming of the warm, dry weather alter that, produce a free 
perspiration, without infiaming the body, turn the humors 
from the bowels that way, and abate the dysenteries^ &c c 



IN THE ISLAND OF BARBADOES. 53 

The whole quantity of rain which did fall in all this 
year 1754, was equal to 87.01 cubical inches deep, which 
is equal to 7 feet 3.01 inches deep, which is a very great 
quantity, as it was an uncommon wet year. 

Upon so much rain falling, dysenteries were more fre- 
quent, and were attended with some symptoms which 
were of a malignant nature, though not more inflammato- 
ry; wherein moderate bleeding once, ipocacuanha, rhu- 
barb and opiates, with gentle restringents and sudorifics 
not too much heating, were the most successful: and when 
the disease proved more obstinate, the ipocacuanha in 
small doses, several times repeated (as mentioned in the 
following treatise) generally procured a free diaphoresis, 
and carried the disorder off. To some a dose or two of 
the stibium ceratum, when the fever and inflammation 
were taken off, was of great service; as this medicine sel- 
dom succeeds till that is abated or taken off: an observation 
which has not been taken sufficient notice of in giving the 
stibium. 

The febricula also seized some few, and when properly 
treated, was not dangerous* and those who were not bled, 
or but very sparingly, recovered much sooner: but where 
the lancet was too hastily and too freely used, it was of 
bad consequence; as I saw in some cases where they had 
been too hasty w T ith the lancet before I came: though I 
saw none that died, yet some were in great danger from it, 
and I heard of some who died by it. 

Many were afflicted with boils, and some with larger 
imposthumations; and we had no other diseases but these 
which could be called epidemical. 

The month of January was generally dry, though we 
had a few small showers at times, and it was also more 
cool than usual; and the most pleasant weather that I ever 
saw. in the West Indies. The quantity of rain which fell 
in this month, was only equal to 1.20 cubical inch deep. 
The lowest the thermometer ever was in the morning, 
was at 72, the highest at 77; the lowest it ever was at 
noon, was at 77, the highest at noon was at 81. The low- 
est the barometer, was at 29. 8, the highest was at 29.9, 



54 ON THE CHANGES OF THE AIR, &c. 

And as this month was cool and pleasant, it was also 
the most healthful; so that I cannot say that we had any 
diseases that were epidemical. 

February was rather more cool, and full as pleasant as 
the last month; and I found Fahrenheit's thermometer in 
the mornings, as low as 70 degrees, which I never saw it 
before, or since, in eleven years time. 

The quantity of rain that fell in this month, was only 
J. 41 cubic inch deep. The lowest the thermometer was 
in the morning, was at 70, the highest at 75; the lowest 
it ever was at noon, was at 77, and the highest at noon 
was 81. The lowest the barometer, was at 29.8, and the 
highest was at 29.9. 

February was as dry, pleasant, and cool, as the last 
month, and no less healthful, for we had no epidemical 
disease till near the latter end of it, when a catarrhal fever 
seized several; first with a cold rigor, which in some con- 
tinued four or five hours, in others no longer than one 
or two, then was succeeded by a hot fever, with great 
pain in the head : some had pain in their back and all 
over them, but most of them had pain only in the head, 
which continued in some but one day, in others two or 
three days, and in some longer, and then in some went off 
by a critical warm sweat; but in most an inflammation 
came on in one leg (something like the fever which pro- 
duces the eliphantiasis, but without any swelling in the 
inguinal gland, or the red stroke from it to the leg, nei- 
ther was it that fever) and it became much inflamed, and 
looked very red, like the skin of one in the scarlet fever; 
and in some, little small blisters rose on the leg like an 
erysipelas, upon which the fever abated and went grad- 
ually off by this imperfect crisis, and the cuticula peeled 
off after as in an erysipelas, or the scarlet fever, and they 
soon recovered: in others, when the morbid matter was 
not thus cast upon the leg, or some other part, the fever 
continued a little longer, and was carried off by once 
moderate bleeding, and encouraging a free diaphoresis 
with cooling sudorifics, as sal. nitre, camphor, spir. mindc- 
reri,acetum camphorat. and diluting plentifully with warm 
wine-whey, most commonly in four or five days time. 



IN THE ISLAND OF BARBADOES. 55 

Their blood was generally very florid, and a little infla- 
med, but rarely sizy. 

Asthmatical and phthysical people suffered much 
from this catarrh; others had it and a cough like a com- 
mon cold, and a few escaped having either more or less 
of it; so that it might be said to be truly epidemical, and 
most probably did arise from this unusual coolness and 
dryness of the air, rarely felt in this warm climate. 

The month of March was rather more dry than the 
two preceding months; and more cool than usual in such 
dry weather. The quantity of rain which fell in it, was 
only equal to 0.66 parts of a cubic inch deep. The lowest 
the thermometer was in the morning was at 72, the high- 
est was at 77; the lowest it was at noon, was at 78, and 
the highest at noon was at 82. The lowest the barometer, 
was at 29.8, and the highest was at 29.9. 

Catarrhs, coughs, pleurisies, and peripneumonies, now 
became more frequent, especially the last: their blood 
was now generally more or less sizy and inflamed, and 
both it and the pleurisies required pretty large repeated 
bleedings, with antiphlogistic pectorals, and expectora- 
ting medicines; for in general they expectorated little 
without the assistance of the last. 

Several children had that exanthematous eruption call- 
ed the chicken pox; and some few on the east side of the 
island, still had the hooping-cough: and we had no other 
diseases that were epidemical. 

April was dry, except a few showers which fell on three 
or four days, but it was warmer than the three preceding 
months; though some days were suddenly cool, then warm 
again. The quantity of rain which fell in this month, was 
equal to 2.17 cubical inches deep. The lowest the ther- 
mometer was in the morning, was 75, the highest was 79; 
the lowest it was at noon was at 79, and the highest at 
noon was 84. The lowest the barometer, was at 29,84;,. 
and the highest at 29.94. 

These sudden changes in the air produced catarrhs, 
coughs, and some peripneumonies and quinseys, but not of 
a bad kind, nor the inflammation attending them very great; 
and if taken in time were not difficult to be cured, by 



56 ON THE CHANGES OF THE AIR, &c. 

bleeding and the above mentioned antiphlogistic method. 
The chicken-pox continued among children: some had '** 
the pictonic cholic, or dry belly-ache, which was generally 
removed in four or five days time, by the method here- 
after mentioned.* 

And some seafaring people had the putrid bilious or 
yellow fever. 

In the month of May we had frequent showers of rain, 
which with the clouds intercepting the hot rays of the 
sun, always cool the air considerably; so that this month 
was more cool than usual in other years. The quantity 
of rain which fell this month, was equal to 6.62 cubic 
inches deep. The lowest the thermometer was in the 
mornings, was 76, and the highest was 80; the lowest 
it was at noon, was at 80, and the highest was at 85. 
The lowest the barometer, was 29.8, and the highest at 
29.9. 

As this month was so cool and pleasant, it was also 
more healthful; so that except a few catarrhs and quinseys, 
we had no diseases that seemed to be influenced by the 
state of the air, or that could properly be called epidem- 
ical; and it was in general very healthful. 

We had frequent great showers of rain in the first part 
of June, so that it was wet and more cool than this month 
usually is; but the latter part of the month was more 
dry. The quantity of rain which fell in this month, was 
equal to 5.84 cubical inches deep. The lowest the ther- 
mometer was in the morning, was 76, tire highest was 
80; the lowest it was at noon, was 80, and the highest was 
at 86. The lowest the barometer, was at 29. 8 ( , and the 
highest was at 29.9. 

As this month was also cool, it was likewise in gene- 
ral healthful. We had only a few catarrhs, coughs, and 
pleurisies; and some dysenteries among negroes: but this 
as well as the four preceding months, were more than 
usually cool and healthful. 

* See the following treatise. 



IN THE ISLAJSD OF BARBADOES. 57 

We also had frequent showers of rain during the month 
of July, but it was more warm than the last month. The 
quantity of rain which fell in this month, was equal to 
5.70 cubic inches deep. The lowest the thermometer was 
in the morning, was 78, the highest was 80; the lowest it 
was at noon, was at 82, and the highest at noon was at 86. 
The lowest the barometer, was at 29.8, and the highest 
was at 29.91. 

The diseases we had this month, principally affected the 
abdomen; for now the humors had an uncommon ten- 
dency towards the viscera of the lower belly, as in the last 
year at this time : and some were seized with an inflam- 
mation of the bowels; others with a cholera morbus; and 
several with diarrhoeas with much griping pain; in some 
with a fever; others had little or no fever with it: in both 
they usually had a sickness at their stomachs, and their 
stools were mixed with a good deal of viscid pituitous 
mucus. This diarrhoea seized children more frequently 
than adults; though several of the latter had it. Those 
who had not a vomit given at the beginning of the dis- 
ease, generally had it in a more severe degree, and were 
more difficult to cure; especially when they were reduced 
low by it: and some died of it. Some had dysenteries with 
very bloody stools, &c. and several had the putrid bilious 
fever, especially strangers. 

Arthritics also suffered much from this disposition of 
the humors towards the viscera, which usually carried 
the gouty humor to them, from whence it w r as some- 
times difficult to remove it to its proper place, the extreme 
parts.(28) 

The month of August was warmer than the last month, 
though we had more rain in this, than in the last. The 
quantity of rain which fell in this month was equal to 6.28 
cubical inches deep. The lowest the thermometer was in 
the morning, was at 78, and the highest at 81; the lowest 

(28) A diarrhoea from gout, has been found to be an obsti- 
nate disease in all countries. It has received, in Virginia, the 
name of 4C a downward consumption," from its so often termina- 
ting fatally, in common with the consumption, from a disease in 
the lungs. 

H 



58 ON THE CHANGES OF THE AIR, &c. 

it was at noon, was at 83, the highest at 86. The lowest 
the barometer, was at 29.8, the highest at 29.9. 

This frequent rain, as usual here, produced many dy- 
senteries, especially among the negroes; though several 
white people were seized by it also, but it was neither so 
frequent, nor so malignant, as it was in the last and some 
other years. We also had some quinseys, opthalmies, and 
inflammatory fevers, but they were neither attended with 
so high a degree of inflammation, nor so difficult to be cu- 
red, as in some other years; for they were generally remo- 
ved and taken off by bleeding and antiphlogistics, without 
much danger. 

The essera, or prickly-heat, and boils, were frequent, 
especially among children, as usual on the coming in of 
the hot season ; though it was not so sickly as it usually is 
in most other years at this time. 

September was very hot, though we often had showers 
of rain, most commonly in the nights, which cooled the air 
a little. The quantity of rain which fell in this month, was 
equal to 4.56 cubic inches deep. The lowest the thermo- 
meter was in the morning was at 78, the highest at 80; 
the lowest it was at noon, was at 80, and the highest at noon 
was 85. The lowest the barometer, was at 29.8, and the 
highest was at 29.9. 

Diarrhoeas and dysenteries were frequent, as usual at 
this time of the year; though they were not so violent or 
malignant, nor so difficult to cure as in some other years. 
Inflammatory fevers, quinseys, opthalmies, pleurisies, and 
peripneumonies, though not so very frequent, yet were so 
frequent that they might justly be deemed epidemical; 
their blood in general was a little sizy, and when it stood 
till cold, was covered with a thin starch-like pellicle; yet 
not so thick, or so much inflamed, as it is in these diseases 
in some other years. 

Arthritics suffered much in this month also, from the 
gouty humor being turned upon the bowels, and the 
diarrhoea caused thereby, was not easily stayed, or the 
gout turned into its proper course and place. A small 
dose of ipocacuan. viz. gr. iij. in theriac. androm. £i. vel. 
5ss. given and repeated two or three times, at proper dis- 
tances; then warm aromatics with volatiles, and a gentk 



IN THE ISLAND OF BARBADOES. 59 

opiate, commonly answered, with the assistance of the pe- 
deluvium and fcenigmi to the soles of the feet, as before- 
mentioned to carry the gouty humor to the remote parts 
of the body; but in some cases they would not so effectu- 
ally answer, without the assistance of some preparations of 
steel, as the learned Dr. Musgrove judiciously observes.* 

The middle of October was dry, but in the beginning, 
and towards the latter end of it, we had a great deal of 
rain. The quantity which fell in this month, was equal to 
9.54 cubical inches deep. The lowest the thermometer 
was in the morning, was at 78, the highest was 80; the 
lowest it was at noon was at 82, the highest at noon 
was at 85. The lowest the barometer, was at 29.8, the 
highest was at 28.81. 

As the falling of so much rain, rendered the air cooler 
than it was in the last month; a catarrhal fever seized 
many, especially children, for of these few or none, either 
white or black escaped it; and all had it either in a greater 
or less degree: (29) some had it so slightly, that they ate, 
drank, and played as if well, then coughed pretty much, 
and after it returned to their play again as if well: some 
had it in a greater degree; and others were seized with a 
chilliness or gentle rigor, though not observed by some, 
which was succeeded by a hot fever, accompanied with 
pain in the head and back, a sickness at their stomachs, 
and vomiting; but in some the vomiting did not come on 
till the third, fourth, or fifth day, and then it usually was 
mote frequent and more violent, and was attended with 
some symptoms of an inflammation of the stomach; the 
fever and heat continued great, the pulse full, quick, 
tense, and hard, they breathed quick, and some with 
difficulty; their blood was florid and much inflamed, and 
in some very sizy: the cough increased as the dis- 
ease advanced, and they brought up a tough viscid 
phlegm, some a concocted thicker matter, which they 
usually swallowed down into the stomach, and after a 



# De Arthritide Anomola. 
(29) Here we behold another .instance of an epidemic pre- 
vailing among children. It appears to be a form of the in- 
fluenza, or what is commonly called " a catarrhal fever.' 5 



60 ON THE CHANGES OF THE AIR, &c. 

little time vomited up, as children who are not of age 
and sense to spit it out, usually do: some had it so slight- 
ly as to require no medicines; others had it so violently 
as to be in great danger, and some died of it. Bleeding 
those once or twice, and some thrice, with a liberal use of 
antiphlogistics and pectorals, most commonly relieved them, 
and carried it off, if taken in time. This fever did not go off 
by any regular crisis; but the inflammation being abated, 
and taken off by the above methods, the remaining part of 
the morbid matter was discharged gradually from the lungs 
and bronchia, by coughing and expectorating, and they re- 
covered; though it reduced some of them very low before 
they recovered: some few adults had it, but most com- 
monly in a more moderate degree; yet some had it 
more violently. 

We had some peripneumonies, and a few quinseys; 
but except these and the above catarrhal fever in children, 
it was a tolerable healthful season. 

November was much drier, and some days were much 
warmer than any in the last month; * though we had some 



# On the first of November, 1755, which was three days be- 
fore the new moon, a very extraordinary phenomenon happen- 
ed at Bridge-town in Barbadoes. At twenty minutes after two 
o'clock after noon, above an hour after it was high water 
there, the sea suddenly flowed and rose more than two feet 
higher than it does in the highest spring tides, and in three 
minutes time it ebbed so as to be as much lower than the 
usual lowest ebb; and then it flowed again as high as it did be- 
fore: and thus it continued to ebb and flow to this uncommon 
height, and to fall to that unusual lowness, every five minutes, 
so as to leave the sides of the channel dry to a considerable dis- 
tance; but the times between its ebbing and flowing decreased, 
so as to be a little longer, and the water to rise a little less 
each time, almost in arithmetical progression, after the first 
four or five times, till near seven o'clock in the evening, when 
I returned out of the country, and had this account of it from 
several gentlemen who carefully observed it: and it then con- 
tinued ebbing and flowing, though it did not then rise above one 
foot higher, and fall one foot lower, than its usual ebbing and 
flowing m die common tides, and it was then about twenty 
minutes between each time of flowing; and so it continued 
gradually to abate in each oscillation, till after nine o'clock in 



IN THE ISLAND OF BARBADOES. 61 

rain about the middle and at the latter end of the month. 
The quantity of rain which fell in it being only equal to 
4.40 cubic inches deep. The lowest the thermometer 
was in the morning, was at 74, the highest at 81; the 
lowest it was at noon, was 80, the highest at noon, was 85. 
The lowest the barometer, was 29.7, the highest was 
at 29. 8. 



the evening, when the return of the usual tide put an end to 
this extraordinary motion of the sea. This day was remarka- 
bly serene, warm, and dry; we had little wind, and that from 
the east; the face of the sea was calm and smooth before it 
came, and the ships in the bay were not moved by it; but 
the small craft in the channel over the bar, were driven to 
and fro with great violence, and some of them up against 
the bridge: and the water flowed in and out of the harbour with 
such force, that it tore up the black mud in the bottom of the 
channel, so that it sent forth a great stench ; and caused the 
fishes to float on its surface, and drove many of them on to 
the dry land, at a considerable distance, where they were ta- 
ken up by the negroes. Many people were witnesses of this un- 
common phenomenon, which could not be accounted for from 
the known cause of the tides, nor from any other natural cause, 
unless we supposed that an earthquake was at some distance 
in the sea, as I then said : though no motion of the earth was 
perceived here by any person on the land, or in the ships in 
the bay; neither was any noise heard, either from the earth, or 
in the air. 

But two months after this, we received an account of a 
most dreadful earthquake, which happened on the same day at 
Lisbon in Portugal, and destroyed the greatest part of that 
populous rich city. 

We are told, that the first shock of the earthquake there, 
happened at three quarters of an hour after nine o'clock, and 
the second shock, which was much greater, and agitated the 
river and the sea much more violently there, was at twenty 
minutes after ten o'clock before noon: and the sea at Barbadoes 
was agitated as above; first at twenty minutes after two o'clock 
in the afternoon. The distance between Lisbon and Bridge- 
town is near 3400 English miles, and the difference of time 
is near three hours and a half, which makes seven hours and 
a half; and if the sea was moved at Barbadoes by that earth- 
quake at Lisbon, as it is most probable that it was, then the 
vibrating motion was communicating through so soft a medium 
as the body of the water is, 3400 miles, in seven hours and 



62 ON THE CHANGES OF THE AIR, &c. 

The cattarrhal fever continued most of this month also, 
and spread itself all over this small island, so that few or 
no children escaped it; though some had it so mildly as 
not to be confined in the house by it, when others were 
in the greatest danger in it, or died of it: and in this month 
several who had it, had an inflammatory quinsey accom- 
panying it, the inflammation falling upon the throat at the 
same time. 

I found the crude sal. ammoniac, joined with nitre, to 
be the most powerful attenuant of that viscid sizy lentor, 
in the blood of those who have these inflammatory dis- 
eases, and the greatest antiphlogistic at the same time. (30) 

This fever did not go off by any regular crisis, but 
went off gradually in this month, as it did in the last. I 
also observed, that it did not in all patients fall upon the 
sneiderian membrane, and the bronchia and lungs; but 
in some particular constitutions, it fell upon such other 
parts of the body, as were either naturally weaker, or had 
been rendered so by some preceding disease; and then it 
produced some different symptoms, such as are peculiar 
to those parts upon which it fell, when they are disorder- 
ed, and constantly required some different methods of 
treatment: (31) but as this was an inflammatory fever, and 
appeared as such in all those different shapes, with in- 
flammatory symptoms, they all required bleeding and an- 
tiphlogistic medicines, with variations pro re nata. 



a half's time, which is at the rate of 485^ miles each hour, or 
seven miles and a half in each minute; which is a very swift 
motion to be communicated by percussion, through so soft a 
medium as water is. 

(30) Our author ascribes the efficacy of his compound of two 
nutral salts in inflammatory fevers to their attenuating what his 
master Dr. Eoerhoove, called a morbid lentor in the blood, but 
which modern pathologists have called fibrin, and which they 
suppose to be the effect in its apparently increased quantity of 
diseased action in the blood vessels. The neutral salts lessen 
its quantity by reducing the action of the blood vessels, through 
the medium of the stomach. 

(31) This variety in the symptoms of the influenza, depend- 
ing upon difference of predisposition, has often been observed 
during its prevalence in other countries. 



IN THE ISLAND OF BARBADOES. 63 

We had much rain from the beginning to the middle 
of December, accompanied with brisk, cool winds; but 
from the middle to the end of the month, it was more dry 
and cooler, than in most other years. The quantity of rain 
which fell this month, was equal to 8.91 cubic inches deep. 
The lowest the thermometer was in the morning, was 72, 
the highest was 78; the lowest it was at noon, was at 79, 
the highest at noon was 82. The lowest the barometer, 
was at 29.8, the highest was at 29.9. 

And the whole quantity of rain which fell in all this 
year 1755, was equal to 57.29 cubical inches deep. 

Dysenteries continued to be epidemical in some parts 
of the island, though few in or near the town had it. We 
also had some inflammatory fevers, and a few were seized 
with an inflammation of the bowels, but not many, neither 
was the inflammation great or violent; though the humors 
still continued to have an unusual tendency and afflux to- 
wards the bowels. And arthritics, especially such as had 
weak bowels, suffered much from the gouty humors turn- 
ing that way: but in general it was tolerably healthful. 

The month of January was in general very dry, though 
we had a few small showers at the beginning of it. The 
quantity of rain which fell in it, was only equal to 0.45 
parts of a cubic inch deep. The lowest the thermometer 
was in the morning, was at 71, the highest at 76; the low- 
est it was at noon, was at 76, the highest at noon was at 
80. The lowest the barometer, was at 29.8, the highest 
was at 29.9. 

As the weather was cool, pleasant, and dry, it was also 
in general pretty healthful; except that towards the north- 
east part of the island, they had some dysenteries, which 
were attended with inflammatory symptoms, and a fever 
mali moris, which was often followed with aphthee towards 
the latter end of the disease: but bleeding at the beginning 
of the disease pretty freely, a dose of ipocacuan. and rhu- 
barb and opiates, &c. and the method hereafter mentioned, 
generally rendered it more moderate, and in a little time 
took it off. Though to some it was necessary to give the 
ipocacuanha in small doses after them, which generally 
was successful: though several of them had taken the sti- 



64 ON THE CHANGES OF THE AIR, &c. 

bium ceratum, and repeated it several times before I saw 
them, without much or any benefit from it; but they were 
not bled, or at least not sufficiently, and that remedy sel- 
dom does succeed when an inflammation attends the dis- 
ease, unless it be first taken off by suitable evacua- 
tions, (32) 

We also had some diarrhoeas, which in general were 
more easily relieved. 

February continued to be very dry, and we had no rain 
except a small shower on the 12th, 13th, and 20th nights. 
The quantity that fell in this month, was only equal to 
1.27 cubic inch deep. The lowest the thermometer was 
in the morning, was 70, the highest 76; the lowest it was 
at noon, was at 77, the highest was at 82. The lowest the 
barometer, was at 29.8, and the highest was at 30. 

Though this month was so dry, yet the wind being 
generally in the N. E. points, it was more cool than I 
ever observed it before; for I found Fahrenheit's ther- 
mometer several mornings as low as 70, which is the low- 
est that I ever saw it in Barbadoes; neither did I ever see 
the barometer as high as 30 inches before. And as it was 
thus cool though dry, it was more than usually healthful, 
for we had no diseases which were epidemical. 

March was also dry. The quantity of rain which fell, 
being only equal to 1.52 cubic inch deep. The lowest the 
thermometer was in the morning, was at 73, the highest 
at 78; the lowest it was at noon, was at 79, and the high- 
est was at 83. The lowest the barometer, was at 29.84 ? 
and the highest was at 29.94-. 

This month continued to be dry, and more than usually 
cool in this climate, at this time of the year; and it was 
pretty healthful. 

But I observed that arthritics suffered pretty much in 
this dry, cool season; and several persons were seized with 
the opisthotonos, and the tetany from seemingly very 

(32) This remark is entitled to the notice of the young prac- 
titioner. Purges fail of curing many diseases until they are 
previously weakened, and prepared for expulsion by means of 
blood lettiner. 



IN THE ISLAND OF BARBADOES. 65 

slight causes*.(33) And we had a few catarrhs, and some 
few quinseys; and some had tumors about the parotids, 
fauces, and neck: but in general it was pretty healthful. 

April was very dry, as well as the three preceding 
months; but it was not only warmer than them, but it was 
warmer than usual at this time, especially towards the lat- 
ter end of it. The quantity of rain which fell in this 
month, being only equal to 0,37 parts of a cubic inch deep. 
The lowest the thermometer was in the morning, was at 
75, the highest at 79; the lowest it was at noon, was at 81, 
the highest at noon was at 84. The lowest the barometer, 
was at 29.84- the highest was at 29.9. 

The first part of this month was in general pretty health- 
ful, but towards the latter end of it, some were seized 
with a fever, which is called a wnsx/ts by the Greeks, or a 
xontinued remitting fever> which most commonly came 
on first with a chilliness, not a rigor, which was soon 
succeeded by a hot fever, with great pain in the head and 
back, a sickness at the stomach, and frequent reaching 
and vomiting, so that some could retain little on their 
stomachs, either medicines or nourishment; their pulse 
was usually quick and full, in some a little hard and 
tense: their blood was florid, and of a soft, loose texture, 
but not so much dissolved as it usually is in the putrid 
bilious fever, though something like it during the first 
two or three days of the fever, and very little serum sep- 
arated from the crassamentum; but as the fever increased, 
it became more dense, and separated more serum, though 
it still remained florid. (34) They were very restless, al- 



* Query 13. Did not this continued, dry, cool season, brace 
up the solids, and render them more rigid, and diminish the 
perspiration, and so affect the arthritics? and from this in- 
creased rigidity of the nerves, were not the opisthotonos and 
tetany more frequent, and more easily produced? 

(3Z) From this fact it appears that even the muscular parts 
of the body, as well as the blood vessels, feel the influence of 
the sensible qualities of the atmosphere. 

(34) This account of the blood in the bilious fever accords 
with its appearance in the middle states of America. It be- 
came, our author says, more " dense" in proportion to the in- 



66 ON THE CHANGES OF THE AIR, &c. 

most continually tossing and tumbling, they got little 
sleep, and that disturbed and without refreshing them; 
their skin was generally hot and dry, though sometimes 
moist, and they in a fine breathing sweat: some had large, 
cold, clammy sweats, especially on the extreme parts, 
though very hot about the praecordia. The fever abated, 
and remitted at some certain time, once in every twenty- 
four hours, but still continued, and returned with great 
heat, vomiting, and all the same symptoms at different times 
in the day, in different patients, but usually at the same 
time in the same patient, and generally abated again in 
six, eight, or ten hours time; and thus returned once in 
every twenty-four hours time, without being influenced 
or increased by the heat of the day, as most fevers in this 
hot climate are. Thus it continued to remit, and usually 
came to its a«^v or height, and began to abate a little be- 
tween the fourth and fifth days, and generally came to its 
crisis on the ninth day, and went off when it was properly 
treated. 

Bleeding once at the beginning of the disease, and an 
emetic after it, were of great service, and yet more so if 
a gentle antiphlogistic purge, of manna and tamarinds 
with a little nitre, was given the next day after it; or to 
those who had a diarrhoea, as some few had, a small dose 
of rhubarb after the vomit. In some plethoric constitu- 
tions, bleeding twice was necessary where the symptoms 
indicated it; but I observed that some practitioners were 
too hasty and too free of their lancet at the returns of 
the fever, and that it was prejudicial to the sick. After 
these, the use of soft, smooth antiphlogistics, and a dose 
of syr. e meconio at nights (because I observed, that 
either tinct. vel extract, thebaic, generally brought on a 
delirium, or if present before, increased it) most com- 
monly greatly contributed to carry the fever regularly on, 
and brought it to a crisis, and carried it off by a copious, 



crease of the fever. He must have meant the duration of the 
fever, which being lessened in its violence by bleeding, permit- 
ted the blood to assume its natural separation into crassamen- 
tum and serum. 



IN THE ISLAND OF BARBADOES. 67 

warm, critical sweat on the ninth day; some had a loose 
stool or two also, after which they soon recovered, and we 
had no other diseases that were epidemical. 

May continued to be very dry, and also warmer than 
the last month, till near the latter end of it, when we had 
some rain: the quantity which fell was but equal to 1.12 
cubic inch deep. The lowest the thermometer was in the 
morning, was at 78, the highest was at 80; the lowest it 
was at noon was at 83, and the highest at noon was at 86. 
The lowest the barometer, was at 29.8, and the highest 
was at 29.9. 

Upon the increase of the warmness of the weather, the 
continued remitting fever became more frequent, and 
varied a little in its symptoms: the vomiting was much 
less frequent, and the head more affected, especially with 
violent shooting, darting pain, mostly over the eyes, par- 
ticularly during the exacerbations and returns of the fever; 
and some had a comatous stupor, others were delirious 
during that time: the pulse was full and quick, but gene- 
rally soft, during the first two or three days; but after- 
wards usually became very variable, so that one seldom 
found the pulse the same, in the same patient at different 
times; sometimes it was very quick, fluttering, irregular 
and small, at other times soft and full, then varying be- 
tween these almost every hour; the patient sometimes 
hot and dry, at other times in a profuse sweat, warm at 
one time, at other times cold: the tongue mostly furred 
over and white, sometimes brown; some were very 
thirsty, others moderately so: they generally complained 
of a great languor and faintness; their urine was mostly 
high coloured, in some paler, and with a cloud suspended 
in it, never with a sediment, not even when the crisis 
came on, nor even after it; and I have always observed, 
that a sediment is very rarely seen in the urine in this warm 
climate, in any fever; though it is frequently seen in 
England in most fevers, upon the coming of the crisis, 
and especially in this fever, and is generally like brick- 



68 ON THE CHANGES OF THE AIR, &c. 

dust:* so that little judgment can be formed by inspect- 
ing the urine in this climate, though we frequently can in 
England. 

Notwithstanding these alterations, the fever continued 
to come to its height between the fourth and fifth day, 
when properly treated, and nature was assisted, and not 
hindered by improper practice, and then gradually decli- 
ned and came to its crisis regularly on the ninth day, as 
before, most commonly by a copious, warm, critical 
sweat; in a chance one, by a few loose stools : and I saw 
one gentleman in whom it went off by a copious discharge 
from the glands of the bronchia and lungs, and probably 
some part of the morbid matter by the salivary glands, and 
was brought up by a frequent coughing, and constant ex- 
pectorating and spitting; as I have more than once seen 
in some other fevers in England. (35) 

I observed that giving a vomit in the beginning of this 
fever, when it was attended with so much vomiting, in 
the last month, was of very great service; but now when 
they vomited less, or not at all, and the head was more 
affected, I found that an emetic was of no service, but ra- 
ther hurtful; but that a gentle antiphlogistic purge given 
the first or second day of the disease, was of very great 
service, and generally rendered the fever more mild and 
moderate, than it was when no such purgative was giv- 
en. (36.) 

f §>iiery 14. Does not this proceed from the great heat of the 
climate, where nature is constantly accustomed to a frequent 
and great discharge of the animal salts by sweat, where the 
sweat is always found to be much more salt than it is in 
colder climates; which animal salts are usually carried off by 
the urine in all colder countries? 

(35) The bilious fever, commonly called the break-bone fe- 
ver, which appeared in Philadelphia in the year 1780, termi- 
nated in many cases by a critical discharge from the bronchia, 
known by the name of u sereatus." 

(36) We cure a diarrhoea by creating a new action in the 
bowels, by means of purges. Why should we not check a vo- 
miting in a similar manner, by creating a new and artificial ac^ 
tion in the stomach, by means of emetics ? 



IN THE ISLAND OF BARBADOES. 69 

Except this fever, and not very many had it, we had no 
other diseases which could be said to be epidemical; so 
that it was in general a pretty healthful season. 

The dry, warm weather continued to the middle of 
June, when a considerable quantity of rain fell, equal to 
3.37 cubic inches deep. The lowest the thermometer was 
in the morning, was at 79, the highest at 87; the lowest it 
was at noon was at 82, and the highest at noon was at 87. 
The lowest the barometer, was at 29.84, the highest was 

9Q Qt 

Upon the falling of this rain, the weather became more 
cool and moist; and the continued remitting fever totally 
disappeared, so that I did neither see, nor hear of any, ex- 
cept one that was seized with it after this change. Some 
few had catarrhs, and some were seized with inflamma- 
tions in the breast, though not many; and upon the falling 
of this rain the season in general became healthful. 

From the middle of June, to the end of July, we had 
frequent great showers of rain, and it was much cooler 
than the two preceding months were, and more cool than 
usual in this month in other years. The quantity of rain 
which fell- in this month was equal to 6.75 cubical inches 
deep. The lowest the thermometer was in the morning, 
was at 77, the highest was 80; the lowest it was at noon, 
was at 82, the highest at noon was at 86. The lowest the 
barometer, was at 29. 84, the highest was at 29.9^. 

The weather being in general much cooler, catarrhs be- 
came more frequent, though not very bad; and we had 
some pleurisies and peripneumonies, but not of a bad 
kind; and they were commonly removed by bleeding, and 
the usual antiphlogistic method and medicines. But dy- 
senteries, upon the falling of these rains, became frequent, 
and some of them were of a bad malignant kind: they usu- 
ally came on gradually at the beginning, and the fever was 
very moderate on the two or three first days, and some- 
times scarce perceptible; but on the third, fourth, or fifth 
days, the fever increased much, and sometimes to be vio- 
lent, and the purging also, with much griping pain in the 
bowels, and sickness at the stomach, and frequent stools 
with much blood and brine-like ichor, and much mucus 



fO ON THE CHANGES OF THE AIR, &c. 

was discharged with them; the pulse was very quick, 
sometimes full, but more frequently small, and often hard, 
but always very quick; they were often delirious, and 
their extreme parts cold. Bleeding at the beginning, and 
repeating it as the fever, Sec. indicated; ipocacuanha, rhu- 
bard, and opiates, with antiphlogistic restringents and opi- 
ates, were the most successful in general, with ipocacuan. 
in small doses. But in some cases, though these were gi- 
ven in the most cautious and judicious manner, they did 
not give that relief, nor answer as they usually do in other 
years to some patients, neither did the ipocacuanha in 
small doses; yet the antiphlogistics with subacid restrin- 
gents and antiseptics with small doses of opiates (and the 
testacea to some children, with antiphlogistics and gentle 
anodynes) answered better, and often prevented a morti- 
fication from coming on in some patients; but in some 
few others, after four or five days more, though the stools 
had been brought by these methods to be more stercora- 
ceous, and they seemed to be something better, the stools 
returned with more violence, and the pulse became more 
frequent, small, quick, and irregular, the extreme parts 
grew cold, with cold clammy sweats, the delirium increa- 
sed, a coma came on, and nothing could prevent the fatal 
period; and they died with all the symptoms of a mortifi- 
cation of the bowels. This was the case of a few; but 
others in general when bled and vomited at the first, and 
then giving the ipocacuanha in small doses, and opiates, 
with antiphlogistics and subacid restringents and gentle 
opiates, generally recovered, though not without great dif- 
ficulty and danger: but as this disease continued, it be- 
came less malignant, and more moderate than it was at its 
first coming.(37) 

We had a considerable quantity of rain through all the 
month of August, though but in showers, and it was often 
clear and hot between them; and from the middle of the 



(37) This remark applies to nearly all great and mortal epi- 
demics. They become less fatal just before they disappear than 
they were in their first and middle stages. 



IN THE ISLAND OF BARBADOES. n 

month to the end of it, it was very warm, as we had but 
little wind, and it was often calm. The quantity of rain 
which fell in this month, was equal to 3.89 cubic inches 
deep. The lowest the thermometer was in the morning, 
was at 78, the highest was 80, the lowest it was at noon, 
was at 82, and the highest at noon was at 86. The lowest 
the barometer, was at 29.8, the highest was at 29.9. 

The dysentery continued, and became more frequent, 
especially among children, but was not quite so malignant 
as in the last month; for now by bleeding once or twice, 
and in a chance-one thrice, a dose of ipocacuan. and rhu- 
barb with an opiate after it, and a few small doses of the 
former after that, and antiphlogistic subastringents with 
opiates, they generally recovered. (3 8) To children, after 
bleeding once or twice, a few small doses of ipocacuan, 
from gr. u to gr. ij. and a little rhubarb with an anodyne, 
then sal. nitre, coral, rubr. vel pulv. e bolo c. equal quan- 
tities, in the julep e cret. or such like mixture with an ano- 
dyne, generally checked it, and took it off in four or five 
days time. 

Ophthalmies were also frequent, but were generally car- 
ried off by bleeding, and two or three cooling purges, and 
a cooling, repelling collyrium: and we had also a few pleu- 
risies and inflammatory fevers. 

The continued remitting fever which we had in May 
and June, and disappeared on the falling of the rain towards 
the latter end of June, and was not seen for near two 
months, now returned again about the middle of this 
month, soon after the return of the hot weather; but now 
differed in some of its symptoms from what it was then: 
now the fever was continual during the three or four first 
days, and then usually remitted regularly as it did before; 
but the remissions were longer, and the fever higher on 
its return, which usually continued five or six hours; the 
pain in the head was greater, not only during the first 



(38) We see here another proof of our author's boldness in 
the use of the lancet, and of its success in a climate in which it 
has. been universally supposed to be hurtful. 



72 ON THE CHANGES OF THE AIR, &c. 

three days, but in the returns of the paroxisms; the pulse 
was usually quick and full at that time, in some it was at- 
tended with vomiting, in few with loose stools; and after 
five or six hours the fever abated, and the pulse was lower, 
though often quick and small, and in some a little languid, 
and some seemed to have little or no fever for several 
hours, as if it would intermit, but it never did; neither 
would suitable evacuations bring it to intermit, as they 
often do in England: the thirst was great in all, even when 
the fever was lowest; the tongue was covered with a white 
or brown slough; their sleep little, and that greatly dis- 
turbed; some had nervous twitchings and slight subsultus 
tendinum, but these mostly in the paroxisms; they gene- 
rally were low and languid when the fever abated, or was 
most remiss: and it usually now came to a crisis on the 
fourteenth day, when properly treated, and neither raised 
too high by too warm medicines, nor brought too low 
by too great evacuations, or over- cooling a regimen, and 
was carried off by a general, copious, warm, critical sweat. 

Those who had lax, weak, or gross phlegmatic consti- 
tutions, required medicines that were a little warmer, and 
some volatiles, to be given with the other; when those 
who were more plethoric, and had rigid, tense solids, re- 
quired larger bleeding, and antiphlogistics, and sometimes 
emollients with some of the milder volatiles, with suitable 
variations pro re nata.(39) 

At this time several were afflicted with the haemorrhoids 
or piles, both internal and external, which were attended 
with inflammation and much pain in those parts; which 
were generally removed by the use of proper sulphurous 
medicines, fomentations, &x. 

The month of September was very warm, the wind be- 
ing mostly in the south, or in some of the southern points, 
and often attended with thunder and lightning, and much 



(39) In thus keeping the fever within the limits of the opera- 
tions of nature, by depleting or cordial remedies, according to the 
state of the system, without attempting to shorten its course, 
our author shows himself to be a disciple of Dr. Sydenham*-- 



IN THE ISLAND OF BARBADOS 73 

rain, and often calm, or very little wind; so that it was 
very hot. The quantity of rain which fell in this month, 
was equal to 7.69 cubic inches deep. The lowest the 
thermometer was in the morning, was at 78, the highest 
at 82; the lowest it was at noon, was at 82, and the highest 
at 85. The lowest the barometer, was at 29.7^, and the 
highest was at 29.9. 

Dysenteries still continued to be frequent, and now were 
epidemical all over the island, both among the white and 
black people, and was often of a bad kind, and difficult to 
be cured, especially towards the latter end of the disease; 
even after the fever and its bad symptoms were taken off, 
by bleeding and antiphlogistic subastringent medicines, it 
was difficult to corroborate and strengthen the great re- 
laxed state of the intestines, and divert the uncommon 
afflux of the humors from them. 

Some few were seized with the continued remitting fe- 
ver still, though not many; the symptoms were much the 
same as in the last month. 

And I saw several patients who had both this fever, and 
the dysentery at the same time, which were evidently dis- 
tinguishable from each other, by their peculiar symptoms; 
as a distinct remission of the fever, and its returning at or 
near the same time; and most commonly in the evening, 
as that fever now usually returned: when at the same time 
the dysentery, with great pain in the bowels and griping, 
bloody stools, continued also; and this last was most com- 
monly removed; and totally ceased or taken off, several 
days before the other fever came to its crisis; which it usu- 
ally did on the fourteenth day, in this case also, as well as 
when it was alone: and it has been observed by others, 
that two different diseases, when both were epidemical at 
the same time, frequently do partake of each other's symp- 
toms in the same patient, at the same time*, as I have also 
observed before.f (40) 

* Dris. Sydenhami Opera. Dris. Rogers. 

f Hillary on the small-pox and epidemic diseases. 

(40) The editor has seen a few sporadic cases of the haemorr- 
hagic dysentery described by our author, and is sorry to add, 
they were generally fatal. He supposes the blood came from 
the liver. 



U ON THE CHANGES OP THE AIR, fee- 
Several children, and some few adults, were seized with 
a haemorrhage from the intestines, and voided considera- 
ble quantities of blood that way, without any fever, sick- 
ness at their stomach, and without griping or much pain, 
or much excrement or mucus, or any symptoms of the 
dysentery; (41) and soon were well again with only taking 
a little styptic tincture: and I observed, that several persons 
who seemed to be well, and walked about their business, 
had unusual loose stools, some for a longer, others for a 
shorter time, and then ceased without taking any medi- 
cines; kind nature having thus discharged the infectious 
matter that way, without any assistance. And likewise, 
that those who were seized with pleurisies, usually had a 
purging during the three or four first days of the disease, 
which then ceased by bleeding, without any medicines to 
restrain it.* I could not observe that we had any other 
epidemical diseases at this time. (42) 

in the month of October we had frequent showers of 
rain, and sometimes much heavy rain, both with and with- 
out thunder; and often much lightning without either of 
them; and the weather was cooler than usual in other 
years in this month. The quantity of rain which fell in it, 
was equal to 5.44 cubical inches deep. The lowest the 
thermometer was in the mornings, was at 75, the highest 
at 82; the lowest the thermometer was at noon, was at 
78, and the highest was at 86. The lowest the barometer, 
was at 29.8, and the highest at 29.9. 



(41) We observe in this paragraph a form of dysentery which 
occurs occasionally in all countries. The haemorrage, when 
moderate, is favourable, but when profuse, is generally fatal. 

# §>iiery 15. Was not this uncommon disposition and afflux 
of the humors to the bowels, principally caused by the falling of 
so much rain and cooling the air, and thereby diminishing the 
perspiration, and turning the perspirable matter and sweat too 
suddenly upon the bowels ? Especially as they had been great 
before, and the fluids much rarified by the preceding warm- 
ness in the months before ? 

(42) We see here a mixture of pleurisy with a discharge 
from the bowels, similar to the febris introversa of Dr. Syden- 
ham. 



IN THE ISLAND OF BARBADOES. 75 

Upon the weather being more cool, the continued re- 
mitting fever totally ceased and disappeared; but the dy- 
sentery still continued, with full as bad symptoms, and 
was no less difficult to be cured than it was in the last 
month. 

"W e also had some pleurisies and inflammatory fevers, 
in several of which a diarhcea, and in some few a vomit- 
ing accompanied them during the two or three first days, 
but was generally abated or totally stayed by bleeding; 
as it arose from too great a plethora, the relaxation or 
weakness of the intestines, and the unusual disposition of 
the humors to flow towards the bowels; after which an- 
tiphlogistics generally took off the disease successfully. I 
also observed the same disposition of the humors to- 
wards the bowels, in most other diseases; and even where 
a cathartic was given in any other case, that a much less 
dose would answer the purpose, than usually did at other 
times: and arthritics also suffered much from this dispo- 
sition of the humors. (43) 

During both this and the last month several persons had a 
diarrhoea alba, or white flux, in which their stools were more 
white than usual in a jaundice, though no yellowishness 
appeared in their skin or eyes, neither had they pain in 
the region of the liver, or in the biliary ducts, nor any 
other icterical symptoms; neither had they any unusual 
acidity in their stomachs or bowels that I could observe; 
yet their stools were more white, than if their diet had 
been only milk, bread and flour, &x. and that in several 
adults whose diet was the reverse; neither were their stools 
chilous, as in a lientery: but these were generally 
pretty soon relieved by a vomit, or a few small doses of 
ipecacuanha, and a little rhubarb with an opiate. (44) 



(43) A good hint to physicians in the choice and use of 
purges! 

(44) The disease thus minutely described by our author appears 
to be what the editor in another place has called the " dia- 
betes chylosus." It is both oi an acute and chronic nature. 
Children are ottener affected with it than adults. It exists 
without any obvious signs of disease in the Jiver and stomach. 



76 ON THE CHANGES OF THE AIR, & c . 

We had frequent showers in November, though not 
quite so much rain as in the last month; and they both 
were more cool than they usually are in other years. The 
quantity of rain which fell in this month, was only equal 
to 3.75 cubic inches deep. The lowest that the thermom- 
eter was in the morning was at 74, the highest at 79; the 
lowes it was at noon, was at 80, and the highest was at 
83. The lowest the barometer, was at 29.8, and the 
highest was at 29.8;. 

The dysentery still continued, though not quite so fre- 
quent as it was in the two last months, nor altogether so 
malignant, or difficult to be cured. 

We had also a few inflammatory fevers, and some 
pleurisies, peripneumonies, and quinseys, towards the 
latter end of the month, but not many; neither were they 
in general of a bad kind, but were usually taken off by 
bleeding, and the use of proper antiphlogistic medicines: 
and no other diseases appeared which could be called epi- 
demical. 

December was in general cool, and we had frequent 
showers, and sometimes pretty heavy rain; and on the 
26th we had a flood. The quantity of rain which fell in 
this month, was equal to 5.44 cubic inches deep. The 
lowest the thermometer was in the morning, was at 74, 
the highest at 76; the lowest it was at noon, was at 76, 
and the highest was at 82. The lowest the barometer, was 
at 29.74, and the highest was at 29.9. 

The whole quantity of rain which fell in this year, was 
but equal to 40.61 cubical inches deep. 

We still continued to have some dysenteries, and a few, 
diarhceas, though not many of either: we also had a few 
inflammatory fevers, but they were all more mild and 
benign than they were in the preceding months. Some 
had a catarrh, and others a choriza, but in so moderate 
a degree, that they were usually carried off in a few days, 
by only drinking sack-whey, tea, or other small liquors 
warm. 

The month of January was in general cool and dryj 
but the instrument with which the quantity of rain falling 



IN THE ISLAND OF BARBADOES. 77 

in each month and year being broke, and a new one not 
to be had here, my worthy friend could not carry on his 
experiments any longer; so that I cannot give the exact 
quantities this year, but shall mention when we had any 
considerable quantities of rain; and how the thermometer 
and barometer stood, as I have done before. 

The lowest the thermometer was in the morning, was 
at 70, the highest at 75; the lowest it was at noon, was 
at 77, and the highest at noon was at 80. The lowest the 
barometer, was at 29.8, and the highest at 29 9. 

The diseases we had in this month were mostly of the 
inflammatory kind, and chiefly those which affected the 
head and breast; though in the preceding months, the hu- 
mors had an uncommon afflux towards the bowels, and 
lower parts of the body, during the wet season; but it be- 
ing now cool and dry, the humors seemed to take a differ- 
ent turn towards the superior parts, and fell principally up- 
on the head and breast, and produced catarrhs, corizas, 
quinseys, peripneumonies, pleurisies, and paraphrenitises, 
all which are diseases of the inflammatory kind; but the 
pleurisies were most of them of the nothous kind, and so 
were some of the peripneumonies, and did not require so 
large bleeding, especially the first; after which it was usu- 
ally carried off by the use of antiphlogistic pectorals with 
some volatiles, and an antiphlogistic purge or two; for 
these seldom expectorated any thing material, neither 
were expectorating medicines of much service, when they 
were given, as I observed in several where they had been 
given before I was called to them.(45) The other inflam- 
matory diseases were generally carried off by bleeding, 
and a free use of antiphlogistics. 

The month of February was also cool and dry, except 
that on the 18th day a considerable quantity of rain fell. 

The lowest the thermometer was in the morning, was 
70, the highest at 75; the lowest it was at noon, was at 

(45) The nothous pneumonies of our country generally re- 
quire prompt and copious bleeding. Our author is correct in 
remarking that they seldom go off by a discharge from the 
lungs, especially where sufficient bloodletting ha.s been em- 
ployed. 



78 ON THE CHANGES OP THE AIR, &c. 

76, and the highest was at 80. The lowest the barome- 
ter was at 29.8, the highest was at 29. 9-J. 

This month was cool and pleasant, and more healthful 
than any time that I can remember in the ten years past ; 
as we had no diseases which could be said to be epidemi- 
cal, except a fever of the inflammatory kind, which seized 
some children and young people, and but very few adults: 
it usually came on with a gentle chilliness, not a rigor, 
which seldom continued more than half an hour, with a 
little sickness at their stomachs, after which a fever came 
on, with a quick, and mostly a full pulse, great heat, and 
soon after a pain in one thigh, leg, and foot ; in some in 
one arm, not in both these, nor in both legs, nor both 
arms; and as the fever increased, the pain in the leg, or in 
the arm, increased and swelled and looked very red, like 
that of the scarlet fever, or rather like that of the elephan- 
tiasis fever, but it was not that fever; in some the fever 
was so high as to cause them to be delirious, in others to 
be comatose ; in some a cough came on, at the first, with 
it, in others the cough did not come on till the third or 
fourth day, and in some was very troublesome, in others 
it was much less so; after bleeding once moderately, and 
giving some antiphlogistics, the fever began to abate, and 
the swelling and inflammation in the leg or arm increased, 
and looked very red, and as that increased, the fever aba- 
ted, and gradually went off in six or seven days time; and 
the swelling and inflamed redness on the leg or arm went 
off also, with the use of emollient, apperient fomentations, 
and incouraging the part to sweat after fomenting it, by 
keeping it warm in flannel, in a few days time, and then the 
cuticula peeled or scaled off; and they were well. 

When this fever was treated with alexipharmic medi- 
cines, or a hot regimen, as some did, the inflammation 
and fever were increased, and it generally ended in an ab- 
scess, which being opened, it discharged much matter for 
a considerable time, and greatly reduced the sick; and did 
not relieve them near so soon, as when it was carried off 
by sweating the part, as above, in the way which nature 



IN THE ISLAND OF BARBADOES. 

indicated, neither did they recover near so soon. Others 
were so imprudent as to give the cortex peruviana, upon 
the abating of the fever; which produced irremoveable ob- 
structions, (as the great professor Boerhaave says it will 
in such inflammatory cases, as I have several times seen 
it, and sometimes predicted its doing so) which ended in 
a large abscess, or abscesses, from which, when they lay 
deep, the acrid matter was absorbed, and produced a vio- 
lent hectic fever, which, with the great discharge from the 
abscess, sunk the patient in a short time, 

Some people had only a troublesome cough a few days, 
without any fever, and a swelling in the hand or arm came 
on; upon which the cough abated, and went gradually oft* 
as that increased, as also did the swelling in a few days 
after that; so that this was something of the same disease, 
but in a much easier degree; and some had abscesses, who 
neither had the fever nor the cough; nature being thus dis- 
posed to cast off, whatever was thus injurious or offensive 
to her, whether it was from the air, or from some kind of 
infectious miasma, or from whatever other cause it arose, 
by such an imperfect crisis, in this manner. (46) 

We also had some inflammatory rheumatisms, more 
than usual in this warm climate; but they were generally 
carried off by bleeding, a cooling cathartic or two, and an 
anodyne after them, as Dr. Sydenham advises, and the 
use of antiphlogistic medicines. 

The month of March continued to be very dry, and 
more cool than usual; though we had sometimes a few 
small showers in the nights. 

The lowest the thermometer w r as in the morning, was 
at 73, the highest at 76; the lowest it was at noon, was at 
78, and the highest at noon was at 81. The lowest the ba- 
rometer, was at 29.84-, and the highest at 29.94. 



(46) The presence of abscesses in this fever, is a proof of 
the predominance of a centrifugal power in the system. They 
should in all cases, be considered as intimations from nature of 
the propriety of using blisters in the- fevers which accompanv 
them. 



80 ON THE CHANGES OP THE AIR, &c. 

The state of diseases continued to be much the same as 
in the last month. 

The month of April was also very dry, and likewise 
cool till near the latter end of it, when it began to be some- 
thing warmer, but dry. The lowest the thermometer was 
in the morning, was at 74, the highest at 76; the lowest it 
was at noon was at 79, and the highest was at 82. The 
lowest the barometer, was at 29.81, and the highest was 
at 29.94. 

These two months continuing to be very dry and cool 
till near the latter end of the last, the diseases that were 
epidemical, were chiefly of the inflammatory kind, though 
they were not many; coughs and catarrhs were the most 
frequent, and we had a few quinseys, peripneumonies, and 
inflammatory rheumatisms, and a few paraphrenitises ; but 
the depuratory fever, before mentioned, wherein the mor- 
bid matter was cast upon the leg or arm, continued to be 
frequent in both these months, and appeared with the 
same symptoms as in the preceding month; but as the 
weather became more warm towards the latter end of this 
month, the coma attending it was more frequent, and 
something greater, so that the patient usually lay as if 
asleep, and if awakened, he instantly dozed and slept 
again, and continued so till the leg, or arm became infla- 
med, and as that inflammation increased, the coma abated, 
and the fever also, and both went off, and the inflamma- 
tion also after that, as before described. (47) 

Gentle cooling diaphoretics, as the saline julep of sal. 
absinth, succ. limon. &c. and diluents, were the most ef- 
ficacious; though it was most commonly necessary to add 
antiphlogistics, especially to some to abate the too great 
violence of the fever, and also to bleed them; but to others 
who had lax, weak constitutions, it was sometimes better 
to omit bleeding, and most of the antiphlogistics, and only 



(47) The reader will please to attend to this second notice 
which our author has taken of the disposition of the inflammato- 
ry fevers of Barbadoes, to fell upon one of the extremities. We 
shall find the intermittents hereafter, still more disposed to pas? 
out of the system in the same way* 






IN THE ISLAND OF BARBADOES. 81 

give the saline mixture, or to add acet. camphorat, vel 
spir. mindereri, to assist nature to carry off the morbid 
matter in the way which she indicated. 

The month of May also continued to be very dry, and 
more warm, so that the face of the earth was burned 
brown; and scarce any thing appeared green, except the 
trees, shrubs, and some of the sugar canes; and most ponds 
of water were dried up; and we had very little rain in all 
this month. 

The lowest the thermometer was in the morning, was 
at 76, and the highest at 79; the lowest it was at noon, 
was at 82, and the highest was at 85. The lowest the 
barometer, was at 29.9, and the highest was at 30. 

This great drought continuing, and it being more warm, 
inflammatory diseases increased, and became much more 
frequent; as peripneumonies, pleuro-peripneumonies, and 
pleurisies; in which the fever was generally high, the pulse 
quick, full, and most commonly hard ; and their blood was 
sizy and much inflamed.(48) In the peripneumonies, it 
appeared, from the sympto ns attending, that the obstruc- 
tion and inflammation was more in the small branches of 
the pulmonary arteries, than in the branches of the bron- 
chial arteries; but it very often was in them both, which 
always renders the disease much more dangerous and 
often fatal, if not timely relieved by bleeding very largely, 
at the very first appearance of its symptoms: and this, with 
repeating it in some cases, and a liberal use of attenuating 
antiphlogistics, as the sal. ammoniac, sal. nitre, spir. min- 
dereri, &c. and diluting plentifully; also the fumes or 
steams of warm water and vinegar received into the lungs 
by the breath, with fomentations to the breast, were the 
most efficacious both in the peripneumony, and pleuro-pe- 
ripneumony, and if used plentifully, in time, were gene- 
rally successful. 

In some of these patients, an erysipelatose eruption ap- 
peared about the breast, and in others on several parts of 

(48) See here ! another proof of dry and hot weather produ- 
cing inflammatory diseases. The plague of London in the year 
1665, was preceded, Dr. Sydenham tells us, by a hot and dry 
summer. 



82 ON THE CHANGES OF THE AIR, he. 

the body, on the fifth or sixth day of the disease, which 
greatly relieved their breathing, as the great Hippocrates, 
and also Araeteus Capadox, both observe*; and I found 
that the fever also, and all its symptoms were considerably 
abated by and after that eruption, especially when it was 
assisted by the above antiphlogistic attenuating medicines, 
and the use of aperient sudorific fomentations to the breast, 
or parts where it appeared, and also by bathing their feet 
and legs in the same decoction, or fomentation, as they all 
greatly contributed to revulse that erysipelatose hu- 
mor from the lungs, to the external and remote parts of 
the body; agreeably to the advice of the great Hippocrates 
in epidem. lib. vi. sect. 2.(49) 

Some few were seized with a fever, which first came on 
with a chilliness or gentle rigor, which was succeeded by 
a hot fever, in some the heat was more intense, and more 
moderate in others, but in all with great pain in the head, 
back, and limbs; a little sickness at their stomachs; their 
pulse was quick, full, and mostly hard; their blood was 
generally of a florid red colour, in some a little sizy, but 
not so much so as in those who had the peripneumo- 
ny. (50)^ 

Bleeding once, or those who were plethoric, or had 
strong elastic fibres, twice, in order to keep the fever mo- 
derate; then giving the above antiphlogistic medicines 
pretty freely, usually carried the fever regularly on, and 
most commonly brought it to a crisis on the seventh day, 
when it went off by a copious, warm, critical sweat. 

Several children, and some few adults, were seized 
with a flushing heat and great redness in the face and 
head, both which swelled considerably, but no blisters or 



^ Hippocrat. Areteus Capadox. Cap. de Pluritid. et in 
Cap. de Pulmonar. 

(49) We have here another hint for the use of blisters in fe- 
vers of a ceratriful type. 

(50) Our author in the history of this fever, in describing the 
pulse, does not mention its frequency, wisely marking those of 
its states upon which the indications of cure should be chiefly 
founded. 



IN THE ISLAND OF BARBADOES. 83 

erysipelatose eruptions, like what is usually called St. An- 
thony's fire appeared, with a little pain in the head; some 
were a little feverish, others had no fever; this swelling 
continued four or five days, and then went gradually off 
by insensible perspiration, without much medicine. It was 
of the erysipelatose kind, though no eruption appeared, 
but the humor passed off through the pores without it; 
and the humors continued during this dry, warm season, 
to have an unusual tendency and afflux towards the head. 

The month of June was mostly dry, though we some- 
times had some small showers of rain, and some moderate 
cool winds. 

The lowest the thermometer was in the morning, was 
at 78, the highest at 80; the lowest it was at noon, was at 
80, and the highest was at 86. The lowest the barometer, 
was at 29.81, and the highest, was at 29.94. 

The before mentioned depuratory fever still continued, 
but was something less frequent than it was in the two 
last months; and we still had some inflammatory fevers, 
as peripneu monies, pleuro-peripneumorjies, and quinseys; 
though not quite so many as we had in the two last 
months; but the inflammation and fever in those who had 
them, were full as great, and their blood when cold was 
covered with an inflammatory, sizy, butf-like pellicle, and 
their pulse was generally full, quick, and hard, and ac- 
companied with great pain in the head, as well as in the 
breast, or side. And these were not relieved, and the dis- 
ease taken off without bleeding largely, and that repeated 
several times in some cases, and a liberal use of antiphlo- 
gistics, given in large doses, and that every two hours, or 
oftener; by which the inflammation and fever were gene- 
rally taken off, and they recovered much sooner.* And I 

^ ^iiery 16. Were not these inflammatory diseases caused or 
produced, by the long continued great driness of the five pre- 
ceding months, by which the animal fibres were so braced up as 
to be so tense and elastic, as to be ready to produce an inflam- 
mation from the least accidental cause, as being too much heat- 
ed by exercise, or too suddenly taking cold, when hot, or being 
wet, or any other way stopping the perspiration, and so increase 
ingthe momentum of the fluids? 



84 ON THE CHANGES OF THE AIR,&c. 

must observe, that these antiphlogistic medicines are usu- 
ally given in such small trifling doses, especially by some, 
in this island, and I believe in most other places, that 
they do but little service, especially where the inflam- 
mation is great, and the fever violent; neither can they 
take off the inflammation and conquer the fever, unless 
they are given in much larger doses, and much more fre- 
quently also in some cases. I have seen a pleurisy attend- 
ed with a violent inflammation and fever, and very acute 
pain, and the patient's blood sizy like buff, taken off by 
bleeding once to gxxiv. and giving sal. nitri 5j. sal. am- 
moniac, crud.depur. gr. xij. vel. xiv. in a draught of de- 
coct, pectoral, cum spir. nitri dul. spir. mindereri every 
hour, in the first twelve hours, and every two or three 
hours after, till the patient had taken sixteen or twenty do- 
ses, in the space of thirty-six hours; whereas if they had 
been given in the small, or even in the usual, doses, they 
could have had little effect in that case, even in a much 
longer time; though by thus giving them, the pleurisy 
was taken off, and the fever also, in the space of thirty-six 
hours time.(51) 

The beginning of July was also dry, but we had fre- 
quent showers after, and sometimes pretty heavy rain, so 
that in the whole we had a good deal of rain in this month, 
and it was more cool than the last month. 

The lowest the thermometer was in the morning, was at 
78, the highest at 79 ; the lowest it was at noon, was at 
80, and highest was at 84. The lowest the barometer, 
was at 29.84, and the highest was at 29. 9h 

The depuratory fever still continued in this month, but 
after the falling of the rain, it varied something in several 
of its symptoms, from what they were in the preceding 
dry months; it now came on with a moderate but greater 



(51) However effectual these large, and repeated doses of ni- 
tre and sal ammoniac may have been in reducing the morbid 
excitement of the blood vessels, the system would probably have 
suffered less from the loss oi fifty or sixty ounces of blood, than 
from the powerful impression of two or three ounces of those 
salts upon the stomach. 



IN THE ISLAND OF BARBADOES, 85 

rigor, which usually continued about an hour, and then 
was succeeded by a more hot fever, with a full, quick, 
and most commonly a hard pulse ; great thirst, and great 
pain in the head and back, and in some in the limbs, and 
some were delirious; some had a hot, dry skin, others 
sweated freely; their blood was generally sizy and cover- 
ed with a buff-like pellicle. This continued in some but 
one day, but most commonly four or five days, and then 
nature deposited the morbid matter on the thigh, leg, or 
arm, and very rarely on any gland or glandulous part, as 
sometimes happens in some other fevers, where it now 
usually formed an abscess, and did not go off by sweat- 
ing, as it did in the preceding months; and as the inflam- 
mation in the thigh, leg, or arm increased, the fever aba- 
ted, and when the tumor suppurated and the abscess was 
formed and opened, the fever went entirely off. 

Towards the latter end of the month*, after a consider- 
able quantity of rain was fallen; some dysenteries began to 
appear, but they were not attended with any symptoms 
more than usual. 

The month of August was in general dry and warm, 
though w r e had some small showers, and lightning often, 
and sometimes some thunder; and on the 20th and 3 1st 
days we had much rain; and it was cooler. 



* On the 29th of this month, we had an earthquake in Bar- 
badoes, which continued a little more than half a minute: the 
houses shook very much; but none fell, though some were ex- 
pected to fall, and the earth seemed to rise and fall as if some 
large body had been rolled on under its surface; and a grum- 
bling noise was heard in several places, in the earth, like the 
noise of several carriages passing on the streets, or like a drum, 
or thunder at a distance. The motion caused many people to be 
giddy, and some to be sick and vomit, for some time after it 
was over. I could neither observe any sulphurious or other 
smell to arise from the earth, or to be in the air, either during 
its motion, or after it was over. Neither could I observe any 
alteration in the diseases then reigning, or in those that followed 
after it, which could be rationally ascribed to its effects, or to 
be caused bv it. 



86 ON THE CHANGES OF THE AIR, &c. 

The lowest the thermometer was in the morning, was 
at 76, the highest at 80; the lowest it was at noon, was at 
78, and the highest was at 85. The lowest the barometer, 
was at 29.8, and the highest was at 29.9. 

Upon the falling of this rain, some diarrhoeas appeared, 
and the dysentery became more frequent, especially among 
the negroes; and I observed, that when the dysentery got 
into an estate among the negroes, it generally became in- 
fectious and spread amongst them, so that many more 
were seized with it, and in several it was now attended 
with very bad symptoms. And I have observed the same 
in some other years, though not in all years. 

Bleeding once or twice, and vomiting, and a dose of 
rhubarb with an anodyne; then giving some small doses 
of ipecacuanha, and anodynes with subacid restringents 
after them, and some healing balsamics at the last, were 
generally successful. 

Inflammatory fevers were also frequent, as quinseys, 
pleurisies, peripneumonies, pleuro-peripneu monies, and 
rheumatic fevers; in all which, their blood was generally 
much inflamed; and they mostly required repeated bleed- 
ing, and antiphlogistics to be given liberally, and when 
they were so given, they generally were successful. 

The depuratory fever also continued to seize several 
people in this month, and after it had continued one day 
in some, in others two or three days, the morbid mat- 
ter was cast upon some muscular or fleshy part of the bo- 
dy, and not upon any gland as observed before, which 
is more usual in other fevers, and in other years, where it 
now formed a hard tumor, which was difficult either to be 
suppurated, or to be dispersed; for it now often did not 
suppurate, but dispersed, but not easily, nor in a short 
time; which is something uncommon; however, as those 
tumors rose, the fever abated much, and as they sup- 
purated, or dispersed, it went entirely off. 

The beginning of September was hot and dry till the 
tenth day, after which we had much rain, almost every 
day, and sometimes much thunder and lightning; and 
the rain continued, at times to the end of the month, 



IN THE ISLAND OF BARBADOES. B7 

which rendered it more cool than this month usually is in 
other years. 

The lowest the thermometer was in the morning, was 
at 77, the highest 80; the lowest it was at noon, was at 
76, and the highest was at 85. The lowest the barometer, 
was at 29.8, and the highest, was at 29.9. 

As this month continued to be wet, and more than usu- 
ally cool, dysenteries became more frequent, and were 
attended with some bad symptoms, and were fatal to 
some patients. We also had some pleurisies, peripneumo- 
nies, pleuro-peripneumonies, and inflammatory fevers; in 
which their blood was most commonly much inflamed, 
and covered with a starch-like, or buff-like pellicle. Some 
few were also seized with the before mentioned depura- 
tory fever; and the tumors could now very rarely be 
brought to suppurate, and it often was a considerable 
time before they could be entirely dispersed, even though 
the patient was recovered, and otherways well. 

Not long after the rain began to fall, many were seized 
with a catarrhal fever; and in some it was moderate, and 
they only had a cough, hoarseness, and a coriza, which 
went off in a few days; but others were taken with a cold 
rigor, which usually continued half an hour or an hour, and 
was succeeded by a hot fever, with a great defluxion of 
rheum on the bronchia and lungs, and a violent cough; 
they expectorated little the first two or three days, but con- 
siderably more afterwards; it was frequently accompani- 
ed with a peripneumony, or a pleuro-peripneumony, in 
which the bronchia and lungs were much inflamed; and 
their blood was covered with a starch or buff-like pellicle. 
These required pretty large bleeding, and a liberal use of 
antiphlogistic pectorals; and with which they were most 
commonly relieved. 

Towards the latter end of this month, some few patients, 
in the north part of this island, were seized with a putrid 
synochus fever: but it neither continued long amongst 
them, nor did it spread further into any other parts of the 
island. 

^Ve had a good deal of rain in the month of October, 
and it was also more cool in general, than is usual in this 
month. 



S8 ON THE CHANGES OF THE AIR, &c. 

The lowest the thermometer was in the morning, was 
at 76, the highest at 80; the lowest it was at noon, was at 
78, and the highest at 84. The lowest the barometer, was 
at 29.8, and the highest at 29.9. 

Dysenteries still continued, but were less frequent than 
they were in the two preceding months. And the depura- 
tory fever which we had in the three or four last months, 
now totally disappeared. 

But the catarrhous fever became more frequent, so that 
few escaped having either more or less of it, as in the last 
month; though in some it only appeared as a common cold, 
and went off in the same manner; but in some, the catarrh 
with a colluvies of sharp serous humor fell upon the 
bronchia and lungs, and produced a peripneumony with a 
violent cough, great inflammation, with great difficulty of 
breathing, and all the other symptoms of that disease. In 
some others it fell upon the pleura, and produced a pleu- 
risy, with its symptoms; and in some few, on the medias- 
tinum and pericardium, and produced a paraphrenias: in 
all which the inflammation was generally great, and their 
blood much inflamed, and more or less sizy. 

In some others the inflammation was general, and did 
not fix upon any one part of the body; but they had a fe- 
ver with great pain in the head, and sometimes all over the 
body, a quick, full pulse, and some were sometimes deli- 
rious, or comatous, for the head was usually most affect- 
ed; their blood was inflamed, and very florid, but not sizy 
as in the others above-mentioned. In these, after bleeding 
once, and the use of antiphlogistics, the fever generally 
went oflf by a copious, warm, critical sweat on the fifth day. 
Some had this fever in a much easier degree; they only 
had a feverish heat, with a flushing red colour in their face, 
a pain in the head, with a quick pulse, which continued a 
few hours, and then abated for a few hoars, and returned 
again in the same manner several times, and at last went 
off by a critical sweat on the fifth day, as in the others. 
But those who had the peripneumony, paraphrenias, and 
the pleurisy, required much larger bleeding, and that very 
early in the disease, and sometimes repeating it, and a 



tS THE ISLAND OF BARBADOES. 89 

more liberal and plentiful use of the antiphlogistics, by 
which, if taken in time, they usually recovered>(52) 

The dysentery became more frequent towards the latter 
end of the month, than it was in the beginning of it, and 
was now sometimes accompanied with the last mentioned 
inflammatory catarrhous fever, and usually had more symp- 
toms of that fever in the first two or three days, and then 
it all turned upon the bowels, with a purging, which did 
not carry that fever off; but it increased and appeared with 
all the symptoms of the dysentery, accompanied with much 
griping pain, and bloody brine-like frequent stools, &c. 
In these, bleeding, and the methods hereafter mentioned 
in the treatise on that disease, were usually successful. 

The asthmatic and consumptive patients suffered much 
from this catarrhous fever, and it proved fatal to some of 
them. 

Also the arthritic and rheumatic patients, had more se- 
vere attacks of those diseases, than they usually had in 
other years. 

And I observed that, in general, the inflammations at- 
tending all the inflammatory diseases at this time, were 
more violent than usual, and their blood was more sizy, 
and covered with a thicker buff-like pellicle; and that they 
required more copious bleeding before the diseases could 
be taken off, than they did in other years* in this warm 
climate, at least since I came into this country* 

(52) A delirium is generally considered as an alarming symp- 
tom in pneumony. It is so, because disease affects two parts, in- 
stead of but one part of the body. Our author mentions the means 
of preventing its terminating fatally; and these are, the more 
liberal use of antiphlogistic remedies. 

* Query 17. Did not all these inflammatory diseases arise 
from, or were much increased by, the long continued drj% 
warm weather, during the last six months* which had braced 
up the animal fibres, and rendered them more rigid and elastic, 
and the fluids more dense and dry, and consequently both more 
fit to produce inflammatory diseases, though they did not much 
appear till after the falling of the rain, which rendered the air 
more cool and moist, and thereby contracted the perspiratory 
pores, and considerably diminished that excretion ; did not 



90 ON THE CHANGES OF THE AIR, &c. 

The month of November was, in general, warmer than 
the two preceding months, probably from the wind's being 
often more southerly, though we had more rain in it, es- 
pecially towards the latter end of it, than we usually have 
in most other years. 

The lowest the thermometer was in the morning, was 
at 76, the highest at 78; the lowest it was at noon, was at 
79, and the highest was at 82. The lowest the barometer, 
was at 29.74, and the highest at 29.84-. 

The dysenteries, which began to increase towards the 
latter end of the last month, continued to be more frequent 
most of this; but they began to abate again towards the 
latter end of this month also. And the catarrhous fever, 
which was so frequent in the preceding months, continued 
to be so some part of this; but it greatly abated, and be- 
came much less frequent towards the latter end of it, and 
totally disappeared and left us in the following month. 

Some few -Were seized with a fever, which at the first 
usually appeared in a very irregular manner, and some- 
times with somewhat different symptoms in one patient, to 
what it did in others; but in general it seemed to be the 
nearest to what the Greeks call a w^n*™ or semi-tertian 
fever. It most commonly appeared in all, like a continual 
fever during the first four, five, or six days, and then 
seemed to remit like what the Greeks call a wnxp* or a con- 
tinued remitting fever, and in most continued so, with the 
usual symptoms of that fever for several days, and much 
longer in some, especially if improperly treated. In others 
it had more of the appearance and symptoms of a semi- 
tertian fever, but rarely or never came to intermit regu- 
larly; for intermitting fevers are very seldom or never seen 
in this island now, unless they are brought from some of 



these two causes, thus acting the same way at the same time, 
the one to obstruct the perspiration, and the other to increase 
the momentum of the circulating fluids, by thus jointly acting, 
produce all the above-mentioned inflammatory diseases? And 
as these causes were long continued, were not their effects 
greater, and the inflammations in general much greater, and 
the diseases more violent? 



IN THE ISLAND OF BARBADOES. 91 

the other less cultivated islands, or from some other place; 
though it is said that they were more frequent here before 
this island was cleared of its wood, and cultivated. In this 
fever their pulse was quick and full, and sometimes a lit- 
tle hard; they had a great pain in their head, back, and 
most commonly all over them, especially in their knees 
and joints; their blood was florid and inflamed, but rarely 
covered with a sizy inflammatory pellicle. 

Bleeding them once at the beginning of the disease, and 
the use of attenuating antiphlogistics, generally brought 
the fever either to remit regularly, or to appear as a regu- 
lar semi-tertian fever; and then they both were usually ta- 
ken off by giving saline draughts, or the following saline 
mixture, which last I found to be the most efficacious. 
& flor. chamzemeli. fol. menthee. ana. mi. infund. in aq. 
bull. q. s. ut col. fKvi. colaturae adde aq. menthae spir. 
|iss. sal. absinth §ss. syr. e mecon. fiss. elix. vitrioli 
acid. q. s. ut reducet. sal. alkal. ad stat. nutralem; misce, 
exhibe cochl. tria vel quatuor tertia quaq; hora. 

In some few the fever remitted pretty regularly from 
the beginning, but it never came to intermit; though some 
evacuations were used to such to bring it to intermit, as 
they usually bring this fever to intermit in England, but 
would not do it in this warm climate: but the above sa- 
line mixture took the fever quite off in all that I saw. 

The month of December was more cool than the last 
month, and it was often cloudy, and we had much more 
rain than usual in this month, in other years; as also stron- 
ger or higher winds, especially towards the latter end of 
it. 

The lowest the thermometer was in the morning, was 
at 73, the highest was at 77; the lowest it was at noon, 
was at 78, and the highest at noon was at 82. The low- 
est the barometer, was at 29.7t, and the highest was at 
29. 8t. 

Dysenteries, which were frequent in the beginning of 
the last month, but began to abate towards the latter end 
of it, almost totally ceased in this. 

Some few had the continued remitting fever, as in the 
last month; and in two op three patients it now changed 



92 ON THE CHANGES OF THE AIR, fee- 

to a regular intermitting quotidian fever: and I saw two 
patients who had an intermitting quotidian, without hav- 
ing the remitting fever before it; and these were the first 
regular intermitting fevers that I have seen in this island, 
except such as were brought hither from some other 
places. 

And the bark did not answer in any of these, so as to 
take the fever off, as it usually does in England; or as it 
generally did in those intermitting fevers which were 
brought hither, or as it is said to have done in those who 
had this fever here formerly : though various things were 
now given with the bark, in order to make it more effectu- 
al; as elix. vitrioli acid, camphor, the fixed alkaline and 
volatile salts, allum and nutmeg, &c. and cold bathing. 
Though the fever was but moderate, the cold fit contin- 
uing about half an hour, and the hot fit four or five hours, 
and then it went entirely off by sweating, as usual, and left 
the patient free from any fever for the space of fifteen or 
sixteen hours; yet the bark would not answer, though very 
good: but the following decoction took it off after giving 
a vomit; though a vomit had been given before the other 
medicines also. g> rad. serpent, virg. §ss. sal. absinth. 5'ri. 
misee, coq. in aq. pur. |xx. ad gxii. et cola; colaturae adde 
tinct. terrae japon. gi. misce, exhibe £ii. singulis bihoris, 
vel tertia quaq; hora absente paroxismo. And I found this 
the most successful; and I added cortex peruv. %\. to this 
decoction for some of them, but I did not find that it an- 
swered better than the other. (53) 

January was more dry, and also cooler than the last 
month, though we had sometimes some small showers of 
rain in it. 

The lowest the thermometer was in the morning, was 
at 72, the highest at 76 ; the lowest it was at noon, was at 

(53) The young practitioner will derive benefit from attend- 
ing to this remark. There are intermittents which resist all the 
usual preparations of bark, which yield to the most feeble stim- 
ulants of another class. Our author's formula is one of them. 
Strong camomile and century te^s have been used with equ&l 
advantage in similar cases. 



IN THE ISLAND OF BARBABOES. $3 

76, and the highest at noon was at 81. The lowest the ba- 
rometer, was at 29.7^, and the highest was at 29. 9^. 

The dysentery, which began to abate in the last month, 
dow totally ceased and disappeared in this* 

Several children were seized with an uncommon disor- 
der in this month, and we had it among children here, 
about six or seven years since; but I do not remember to 
have ever seen it in England, or elsewhere. It chiefly, if 
not solely, seizes children; for I never saw any but them 
have it, and none that were above seven or eight years of 
age : they seldom complain, or seem to be much uneasy 
or unwell, till after a great number of small, angry, infla- 
med eruptions, like little boils appear on the head, neck, 
and face, but mostly on the forehead and head ; and it is 
most frequent in those who have had a common sore head, 
as children sometimes have, for -several days or weeks be- 
fore these appear: (54) Some chance one or two of these 
boils suppurate tolerably well; but in general most of 
them do not, but contain a small, tough, white or yellow- 
ish core, and nQt concocted matter: upon, or a little be- 
fore these eruptions appear, the humor which used to be 
discharged from the forehead, suddenly dries up, or strikes 
in, and the boils turn to a livid or blackish colour, and the 
skin round them to a small distance turns pale, and the 
boils begin to gangrenesce; and they now begin to be a 
little feverish, and have a little, small, quick pulse, which 
is mostly low, and they have a great inward heat, and 
thirst, though not the last always: yet the external heat is 
sometimes less than in health, and sometimes the extrem- 
ities are cold, though the pulse is quick, but small and 
low: in some the feet and hands begin to swell, and look 
pale as if cedematous or dropsical, or as sometimes comes 
on a limb before it begins to mortify; a stupor or coma 
comes on, and the scalp becomes more livid, and a mor- 
tification, or even a sphacelus down to the cranium, if not 
on the brain, comes on also, and they die. 



(54) The editor has seen similar eruptions upon the heads> 
necks, and faces of children, in unusually hot summers, in Phi- 
ladelphia. 



94 ON THE CHANGES OF THE AIR, fcc. 

I have known some, who upon the humor's striking in, 
have had all their limbs become numb, like a slight para, 
plegia, but not a total loss of either sensation or motion, 
as in a complete paraplegia, yet they were numb, and in 
part paralytic: this is a very bad symptom-, but the coma 
with a great lividness of the cranium, and the oedematous 
swelling of the hands and feet, are worse, and almost cer- 
tainly presage the death of the little patient, in thirty or 
forty hours time, or sooner. I have been called to some in 
this state, when too late, and have found these symptoms, 
and the scalp down behind the ears as low as the neck, 
quite livid and almost black and mortified, if not sphace- 
lated down to the cranium; and from thecoma, great stu- 
por and insensibility of the patient, I judged that the mor- 
tification extended to the brain, or its meninges. 

In some the fever is a little higher, the pulse stronger 
and a little fuller, and the heat greater, and more equally 
diffused all over the body, and to the extremities; and 
these, provided that the fever is not very high, which rarely 
happens, are in less danger, and if properly treated in 
time, most commonly recover. 

The intentions of cure, are to keep the vis vitae and the 
fever moderate, neither too high, nor to let it sink too low 
(which is the greatest danger) and bring on a mortifica- 
tion, which, in that vital part, must almost certainly end in 
death. All the whole tribe of the testacea which are usu- 
ally given to children, and in some cases are of great ser- 
vice to them, here have no place, and are more hurtful 
than useful, as being sceptics; and the acrid antisceptics 
are in general too acrid for their tender stomachs: but as 
the great disposition and tendency to bring on a mortifi- 
cation on the parts affected, evidently indicate the best and 
Strongest antisceptics to be given, provided that they are 
neither too acrid, nor too strong for such young, tender 
patients; as, a light decoction or infusion of the cortex, 
peruv. rad. serpent, virg. croci anglic. vinum croceum, 
spir. mindereri, spir. lavendul. c, 8cc. properly adapted to 
the age and strength of the child, are the most suitable, 
and promise the best success: and a warming fotus to the 
head, made of aromatic antisceptic herbs, as fol. piemen- 



IS THE ISLAND OF BARBABOES. 95 

ti, viburnii salvae rorismarin. flor. chamemel. sambuc. Sec. 
applied warm three or four times a day; and opening the 
boils with a lancet, as soon as they are ripe and fit to be 
opened, and dressing them with a warm digestive, as lini* 
ment. arcaei, &c. and then covering the dressings and the 
whole scalp, with the cataplasm, maturans. I have found 
this method, if taken in time, always to be the best and the 
most successful. 

Towards the latter end of this month, the exanthema- 
tous eruption, commonly called the chicken-pox, began to 
appear again in some parts of the town. 

The month of February was more dry than the last 
month, and continued to be cool and pleasant weather; 
though we had some small show r ers. 

The lowest the thermometer was in the morning, was 
at 72, the highest at 74; the lowest it was at noon, was at 
76, and the highest was at 80. The lowest the barometer, 
was at 29.84-, and the highest was at 29. 9^. 

As this month was in general very dry, and also mode* 
rately cool and pleasant weather, it was also very health* 
ful; so that we had not any diseases which could be pro- 
perly called epidemical, except the above-mentioned gan- 
grenescent boils on the heads of children, which still con- 
tinued, and were fatal to some; and the chicken-pox. 

March continued to be very dry, rather more dry than 
the preceding month, and likewise cool and pleasant 
weather. 

The lowest the thermometer was in the morning, was 
at 73, the highest at 76; the lowest it was at noon, was 
at 78, and the highest at noon was at 81. The lowest the 
barometer, was at 29.81, and the highest at 29. 94-. 

This month was also no less pleasant and healtful than 
the last, for we had no diseases that were epidemical ia 
either of them, except the above gangrenescent boils, 
and the chicken-pox; till after the middle of the month, 
when some few were seized with coughs and catarrhs, and 
a few had a quinsey; but these were neither bad, nor 
many, neither did they continue long, for they as well as 
the gangrenescent boils and sore head, all disappeared 



96 ON THE CHANGES OP THE AIR, &c. 

before the end of the month, and the season became 
very healthful. 

The month of April also continued to be very cfry, 
though we sometimes had some clouds, yet we had little 
or no rain; and towards the latter end of the month, the 
weather grew very warm, as usual at this time. 

The lowest the thermometer was in the morning, was 
at 75, the highest at 79; the lowest it was at noon, was 
at 78, and the highest was at 84. The lowest the barome- 
ter, was at &9.8, and the highest was at 29.94-. 

The season continued to be pretty healthful most of 
this month, but the weather began to be warm towards 
the latter end of it; when some few inflammatory diseases 
began to appear, as a few pleurisies, peripneumonies and 
some few quinseys, but not many; but several children 
were seized with a suffocating catarrh, in which the glotis, 
epiglotis, bronchia, and sometimes the lungs, were much 
inflamed, and they breathed with much difficulty, though 
they could most commonly swallow liquids tolerably well; 
their pulse was quick, and mostly full and hard, their 
blood was inflamed, florid, and dense, and generally sizy 
soon after; their skin was hot, and the fever and inflamma- 
tion usually high. It generally seized children of two or 
three years old> and those that were younger; and when 
the inflammation of the above-mentioned parts was great, 
it soon suffocated them, if not speedily relieved by bleed- 
ing, and the use of antiphlogistics, &c. and several young 
children died of it. Those who were elder, especially if 
almost grown to be young men and women, got more 
easily over it, and soon recovered by the following anti- 
phlogistic method of treating it. (55) 

Bleeding pretty largely pro ratione setatis et inflamma- 
tionis, at the first beginning of the disease, and giving 
antiphlogistic pectorals freely, and keeping the body open 
by cooling gentle eccoprotic cathartics, and clysters (not 
strong or drastic purgatives), fomentations and emollient 



(55) The disease thus minutely described, appears to be in- 
termediate, between catarrh and lynanche trachsalis. The re- 
medies to which it yielded, prove its affinity to the latter dis- 
ease of our country. 



IN THE ISLAND OF BARBADOES. 97 

repelling cataplasms to the breast and throat, were of 
the greatest service, and the most successful. 

The month of May continued to be very dry, and also 
very warm, and very little rain fell in all this month, ex- 
cept a few small showers. 

The lowest the thermometer was in the morning was at 
76, the highest at 80; the lowest it was at noon, was at 
82, and the highest at noon was at 85. The lowest the 
barometer, was at 29.8*, and the highest wa c at 29.91* 

Though the month of May continued r fo be very dry 
and warm, yet a great part of it continued to be pretty 
healthful, and the season did not begin to be more sickly, 
till after the hot weather had continued three or four 
weeks, when inflammatory diseases began to increase and 
be more frequent; as ophthalmies, quinseys, peripneumo- 
nies, and pleurisies, though we had not a great many of 
these during this month: we also had some vertigoes, 
and a few apoplexies, and palsies, and but few; so that 
it might be called a tolerable healthful season. 

On the thirtieth of this month, I discontinued these 
observations, and returned to England, and I now publish 
them for the benefit of the inhabitants of that island, and 
sincerely wish that they may be of service to them and 
all theirs. 

N 



/. 



TREATISE 



ON * 

SUCH DISEASES 

AS ARE 

THE MOST FREQUENT IN, OR ARE PECULIAR TO 

THE 

WEST-INDIA ISLANDS, 

OR THE 

TORRID ZONE, 

BOTH ACUTE AND CHRONICAL, viz. 

THE PUTRID BILIOUS OR YELLOW FEVER, THE DRY-GRIPES, THE DYSENTERY^ 
THE OPISTHOTONOS AND TETANY, THE RABIES CANINA, THE APHTHOIDES 
CHRONICA, THE NYCTALOPIA, AND HEMERALOPIA, THE ELEPHANTIASIS, V& 
NA MEDINENSIS OR GUINEA-WORM, THE ARABIAN LEPROSY, THE YAWS, AND 
THE IMPETIGO OR RING-WORM. 

BY WILLIAM HILLARY, M. D- 



WITH NOTES, 

BY 

BENJAMIN RUSH, M. D. 

PROFESSOR OF THE INSTITUTES AND PRACTICE OF MEDICINE IN THE UNIVERSITT 

OF PENNSrL VANIA, 



PHILADELPHIA: 
PRINTED BY JANE AITKEN, NO. 71, NORTH THIRD STREET. 



181L 



PREFACE. 



AS I have in the preceding observations taken no- 
tice of all the most material changes of the air and weather, 
and of such alterations as happened in their concomitant 
epidemical diseases: I shall in the following essays, en- 
deavour carefully to observe, iand strictly to trace out, 
and follow nature, both in the descriptions of the diseases, 
and their symptoms, herein treated of, as also in their 
methods of cure, as I possibly can: as that is not only 
the method which the great father and prince of phy- 
sicians Hippocrates advised and followed, but has been 
recommended by the greatest men. The great lord Ve- 
rulam says, observandum est quid natura facit aut ferat. 
And the no less profess. Boerhaave, both observed, fol- 
lowed and recommended the same; and as it is the only 
true basis, on which all true knowledge, both in physic 
and philosophy ought and can be founded. 

As most of the diseases here treated of are either 
such as are indigenous and endemial in the West- India 
islands, or peculiar to the torrid zone; and are seldofti 
or never seen in the colder European nations; it is pro- 
bable that some of them at least, were not so well known 
to many of the ancient Greek physicians, as they have 
not so accurately described them as they have most of the 



1Q2 PREFACE. 

other diseases which they more frequently saw; neither 
have the Arabian physicians so methodically and accurately 
described some of them, as may be desired, though they 
were more frequent in their countries; and are diseases, 
which were still much less known to the more modern 
physicians in Europe. And some of them, I think, are 
new, and have not been described before: wherefore I 
hope that an account, and accurate description of those 
diseases, will not be unacceptable to the public, at least to 
the curious. And as I have had frequent opportunities both 
of seeing, observing, and treating them, I have endea- 
voured carefully to observe, examine, and describe them, 
and all their material symptoms and appearances, as near 
to the manner in which they come on, and succeed each 
other, as I possibly could, both that they may be known 
when seen, by those who have not seen them before, 
as well as by those who have. 

I have also endeavoured to inquire into the nature and 
causes of these diseases, and how they act, so as to pro- 
duce those symptoms and effects, which usually attend 
them, as agreeably to the laws of motion and of the ani- 
mal oeconomy, as I possibly could: and from thence I 
have endeavoured to deduce and discover their true indi- 
cations and proper intentions of cure, more especially in 
those diseases which are new, and have not been descri- 
bed before. 

I have also endeavoured to pursue the same methods 
in those diseases, which have been either too imperfectly 
described by the Greeks, or too inaccurately and immetho- 
dically by the Arabians, though they are diseases which 
were much more frequent in their hot countries, than 
they probably were in Greece; in order to obtain as just 
3 knowledge of them, and their intentions of cure, as I 



PREFACE. 105 

possibly could; and then examined those methods, and 
such medicines as they used and recommended, and 
compared them with those which the modern improve- 
ments in chemistry and the materia medica have produ- 
ced, and have chosen such as seemed to be the most likely 
to answer those intentions and cure in the most efficacious 
manner, in order to form and obtain as rational and ju- 
dicious a practice in them as I could. Which methods 
I have now experienced, and endeavoured to improve for 
some years, and such as I have found to be the most 
successful, I now take the liberty of recommending 
them to my brethren, and others, that they may either 
use or farther improve them, if they can: wherefore I 
have here given more formulae or prescriptions, in this 
second part, than I did in the observations on the air and 
epidemic diseases in the first part; both because some of 
the diseases are new, as also are the methods of treating 
some of the others, and because I principally write and 
publish these for the good of the inhabitants, and the 
benefit of those who commonly practise in the West- In- 
dia islands, many of whom have too small a share of 
learning; for whose sakes I have often been more explicit 
and full in the theory of these diseases, as well as in tra- 
cing out their causes, and their manner of acting, in 
drawing their intentions of cure and describing the meth- 
ods of curing them; which would not have been neces- 
sary if I had written only for the learned: and I hope they 
will be of some service, at least to the younger physicians, 
and the practitioners in those islands, and flatter myself that 
they will be received $s the honest endeavours of a sin- 
cere well-wisher, botli to his profession, and to them and 
all mankind in general 



TREATISE 



ON 



SUCH DISEASES 



THE MOST FREQUENT LM, OR .IRE PECULIAR TO THE 1VE$T 
JNDIA ISLANDS, OR THE TORRID ZONE, BOTH ACUTE AND 
CHRONICAL. 



OF THE PUTRID BILIOUS FEVER, COMMONLY 
CALLED THE YELLOW FEVER. 

THIS disease is most commonly known by the name 
of the yellow fever, from a yellowness like the jaundice 
which diffuses itself all over the body of the sick, towards 
the latter end of the disease. The french call it la maladie 
de Siam, from its being frequent in the kingdom of Siam 
in the East Indies, which is situated between the tropics, 
near the same latitude with the West India islands: they 
also call itla fievre matelotte, because strangers and sea- 
faring people are the most obnoxious to it: and the Span- 
iards call it vomito preto, or the black vomiting, from one 
of its dangerous symptoms. I shall not enter into any dis- 

o 



106 DISEASES, ACUTE AND CHRONICAL, 

pute about the name of this fever, or the propriety or im- 
propriety of calling it a putrid bilious fever, (though some 
have objected to this*) as that is only a dispute about 
words. But as we have no account of this disease in the 
ancients, not even in the Arabian writers, who lived and 
practised in the hot climate; we must give it some name, 
and I think this is the most suitable to the nature and 
symptoms of the disease. 

From the best and most authentic accounts that I can 
obtain, as also from the nature and symptoms of the dis* 
ease, it appears to be a fever that is indigenous to the West 
India islands, and the continent of America which is situ- 
ated between, or near to the tropics, and most probably 
to all other countries within the torrid zone. But I cannot 
conceive what were the motives, which induced a late in- 
genious authorf to think that this fever was first brought 
from Palestine to Marseilles, and from thence to Marti- 
nique, and so to Barbadoes, about thirty-seven years since. 
A better inquiry would have informed him, that this fever 
had frequently appeared in this and the other West India 
islands, many years before: for several judicious practition- 
ers, who were then and now are Hying here, whose busi- 
ness was visiting the sick, the greatest part of their life- 
time, some of them almost eighty years of age, who re- 
member to have seen this fever frequently in this island, 
not only many years before that time, but many years be- 
fore that learned gentleman came to it. 

The same author supposes this fever to be of the pesti- 
lential kind; but his reasons for it are chiefly founded on 
the same supposition, that it proceeded from the plague 
then raging at Marseilles. But a more strict inquiry into 
the nature of its symptoms, and a better examination of 
the state of the blood of those who labour under it, would 
have sufficiently shewed him that it was a very different 
fever: to which I may add, its not spreading and infecting 
others, as the plague always does; for this fever very rare- 
ly or never is infectious or contagious to others, not even 

* Dr. Warren on this fever. f Idem ibid. 



PECULIAR TO THE W. INDIA ISLANDS, &c. 1Q? 

to those who attend the sick, except a chance time, when 
it is in its most putrid, malignant state, at the latter end of 
the disease; or soon after the death of the patient, when the 
season is very hot, and this fever is accompanied with the 
symptoms of some other malignant fever which is then 
epidemical and contagious, as happened once at Antigua, 
and once or twice in this island; and the same may pro- 
bably have happened in some other places: but I never 
could observe any one instance, where I could say that 
one person was infected by, or received this fever from, 
another person who had it; neither have I even seen two 
people sick in this fever in the same house at or near the 
same time, unless they were brought into the same house 
when they had the fever upon them before they came. 
From whence we may conclude, that it has nothing of a 
contagious or pestilential nature in it: and that it is a very 
different fever in all respects, as it will more fully appear 
hereafter. (56) 

It is remarkable that this fever most commonly seizes 
strangers, especially those who come from a colder, or 
more temperate climate, to this much warmer; and most 
readily those who use vinous or spirituous liquors too 
freely; and still more readily those who labour hard, or 
use too violent exercise, and are at the same time expo- 
sed to the influence of the scorching rays of the sun in the 
day-time, and soon after expose themselves too suddenly 
to the cool dews and damp air of the night, and especially 
if they drink spirituous liquors too freely at the same 
time: hence the poor unthinking sailors too frequently be- 
come a prey to this too often fatal disease. 

It does not appear from the most accurate observations 
of the variations of the weather, or any difference of the 



(56) We have here a testimony against the non-contagious- 
ness of the yellow fever, by an eminent physician, who resided 
many years in one of those islands, from which the disease has 
been said to be exported. It is probable, in the few cases in 
which this fever was said to be contagious, there was a mixture 
of the jail or ship fever with it; or the yellow fever may have 
been so protracted as to generate that matter which has been 
called the u contagion of excretion," 



108 DISEASES, ACUTE AND CHRONICAL, 

seasons, which I have been able to make for several years 
past, that this fever is any way caused, or much influen- 
ced by them: for I have seen it at all times, and in all sea- 
sons of the year, in the coolest, as well as in the hottest 
time of the year: except that I have always observed that 
the symptoms of this (as well as most other fevers) are 
generally more acute, and the fever usually higher, in a 
very hot season, especially if it was preceded by warm, 
moist weather, than it usually is when it is more cool. (5 7) 
This fever most commonly seizes the patient, at the 
first with a faintness, then a sickness at the stomach, and 
mostly with a giddiness in the head, soon after with a 
small chilliness and horror, very rarely with a rigor, which 
is soon followed by a violent heat, and high fever, attend- 
ed with acute darting pains in the head and back; a flush- 
ing in the face, with an inflamed redness and a burning 
heat in the eyes, great anxiety and oppression about the 
praecordia; these and the burning heat and pain in the 
eyes, are the pathognomic symptoms of this fever, espe- 
cially when accompanied with sickness at the stomach, 
with violent reachings, and bilious yellow vomitings, and 
great anxiety, with frequent sighing. The pulse is gene- 
rally now very quick, high, soft, and sometimes throbbing, 
never hard; in some it is very quick, soft, low, and op- 
pressed; a quick, full, and sometimes a difficult respira- 
tion: the skin very hot, and sometimes dry, though more 
frequently moist. Blood taken from the patient, even at 
the first beginning of the disease, is often of an exceeding 
florid, red colour, much rarefied and thin, and without the 
least appearance of siziness, and the crassamentum, when 
it has stood till it is cold, will scarce cohere, but fluctu- 
ates; the serum is very yellow: most of the above-mention- 
ed symptoms continually increase, and are much aggra- 
vated; the reaching and vomiting become almost inces- 
sant, the anxiety great, and sighing frequent, great rest- 

{57) This remark does not apply to Philadelphia. The yel- 
low fever has never appeared as an epidemic in it, except in sum- 
mers in which the medium heat of Fahrenheit has been above 
80°. 



PECULIAR TO THE W. INDIA ISLANDS, &c. 109 

lessness, continual tossing, no ease in any posture, little or 
no sleep, and that disturbed, uneasy, and without any re- 
freshment to the sick: and when they are fainting they 
turn yellow about the face and neck instead of turning 
pale, and as the fainting goes off, they recover their natu- 
ral colour again. These symptoms generally continue to 
the third day, though sometimes not longer than the first 
or second day, in others to the end of the fourth day; the 
first shews the quicker dissolution of the blood, and great- 
er malignity of the disease, the last the contrary, or the 
less degree of it; which the improper manner of treating 
the disease sometimes hastens and increases, or the proper 
method retards. This may be called the first stadium of 
the disease, and most commonly ends on the third 
day. (58) 

Blood taken from the sick on the second or third day, 
is much more dissolved, the serum more yellow, and the 
crassamentum florid, loose, scarce cohering, but undula- 
tes like sizy water when shaken, and sometimes has dark 
blackish spots on its surface, shewing a strong gangrenes- 
cent diathesis. 

About the third day, the pulse, which was quick and 
full before, now generally sinks greatly, and becomes very 
low, though sometimes it remains very quick, yet in others 
It is not much quicker than when the patient is in health, 
but is always low; the vomiting grows poraceous, and al- 
most incessant, if not so before, and the patient begins to 
be comatous, attended with interrupted deliria's. The 
thirst in some great, in others not much; the pulse still 
low and quick, attended with cold clammy sweats, and 
sometimes with deliquia. The eyes, which were inflamed 
and red before, and began to be of a more duskish colour, 



(58) The description of the yellow fever here given, accords 
in its symptoms with the same grade of bilious fever in the Uni- 
ted States ; particularly in the history oi the face, of the mat- 
ters discharged in vomiting, and by urme and stool — of the 
parts from whence haemorrhages took place — of the appearan- 
ces of the blood, and of the natural staje of the tongue, skin, 
and pulse. 



110 DISEASES, ACUTE AND CHRONICAL, 

now turn yellow; this yellowness also soon appears round 
the mouth, eyes, temples, and neck, and soon after diffu- 
ses itself all over the body. This total yellowness is so far 
from being always an encouraging prognostic, as Dr. 
Town says, that it most commonly, on the contrary, 
proves a mortal symptom; as it, when it comes soon on, 
shews a greater colliquation and dissolution of the blood, 
and a gangrenescent state of the fluids. I grant that this 
yellow suffusion of bile upon the surface of the body has, 
at a chance time, (though very seldom) proved critical; 
but then it did not come on tiil the eighth or ninth day, 
nor appear till the coma, and all the other bad symptoms 
began to abate, and as the yellowness increases, they all 
decrease; but this very rarely happens. But this yellowness 
is most commonly quite the reverse, especially when it 
comes soon on, and is not only symptomatica!, as it arises 
from the colliquated, putrid, dissolved and gangrenescent 
state of the blood; but it too often ushers in all the last and 
most fatal symptoms of the disease, viz. a deep coma, a 
low vermicular and intermitting pulse, great haemorrhages 
from various parts of the body, a delirium, with a labori- 
ous and interrupted respiration, great anxiety, deep sigh- 
ing, great restlessness, a subsultus tendinum, great cold- 
ness of the extreme parts first and then all over the body, 
a faltering of the speech, tremors, convulsions, and death. 
So that from the first appearance of this symptomatica! yel- 
lowness, we may say, the patient is in the last stage of the 
disease, how soon soever it may come on; though in some 
it has not come on till the eighth or ninth day, and then is 
usually critical, but this very rarely happens. 

It has also been observed, that in some sanguine strong 
constitutions, when they have not been bled to a sufficient 
quantity in the first, second, or third days of the disease, 
to restrain its violence, the pulse has continued full, 
strong, and rapid, but never hard, the face flushed, eyes 
inflamed, the tongue dry, with great thirst and heat, till 
the second or last stage of the fever is come on, when the 
pulse has suddenly sunk, and death has soon after ensued: 
yet in others, who seemed to have plethoric habits, the 
tongue has been moist all along, though they have been 



PECULIAR TO THE % INDIA ISLANDS, &c. Ill 

delirious most of the time, and the heat of their skin, and 
the strength and quickness of their pulse has continued, 
after the first stage of the disease was over, pretty near to 
that of their natural state in health, till within a few hours 
of their death; and when they have had a coma on them, 
one who is not well acquainted with this fever, would from 
their pulse, heat, breathing, and other symptoms, have ta- 
ken them to be in a natural sleep. Others, when the pulse 
has begun to sink, and the fatal period seemed to be just 
approaching, to the great surprize of all present, the pa- 
tient has recovered his senses, sat up, and talked pretty 
chearfully for an hour or two, and in the midst of this 
seeming security, has been suddenly seized with strong 
convulsions, and died immediately. 

I mentioned haemorrhages before, for in the latter stage 
of this fever, the blood is so attenuated and dissolved, that 
w r e frequently see it flowing, not only out of the nose and 
mouth, but from the eyes, and even through the very pores 
of the skin; also great quantities of black, half-baked, or 
half-mortified blood is frequently voided, both by vomit- 
ing and by stool, with great quantities of yellow and black- 
ish putrid bile by the same ways; and the urine, which 
was before of a high ictericious colour, is now almost 
black, and is frequently mixed with a considerable quan- 
tity of half- dissolved blood. The pulse, which was much 
sunk before, now becomes very low* unequal and inter- 
mitting; the breathing difficult and laborious; and the anx- 
iety becomes inexpressible, and an oppression with a bur- 
ning heat about the pi ascordia comes on, though the ex- 
tremities are cold, and often are covered with cold clammv 
sweats; a constant delirium, and then a total loss of reason 
and the outward senses, with livid spots in many parts of 
the body, especially about the prsecordia, and sometimes 
gangrenes in other parts of the body, which are soon fol- 
lowed by death. 

And soon after death the body appears much fuller of 
livid, large, blackish mortified spots, particularly about the 
praecordia and hypoconders, especially the right; which 
parts seem even from the first seizure, to be the principal 
seat of this terrible disease. And upon opening the bodies 



1 12 DISEASES, ACUTE AND CHRONICAL, 

of those who die of it, we generally find the gall-bladder 
and biliary ducts turgid, and filled with a putrid blackish 
bile; and the liver, and stomach, and adjoining parts, full 
of livid blackish mortified spots, and sometimes gangrenes, 
in those, as also in several other parts of the body. And 
the whole corpse soon putrefies after death, and can but 
be kept a few hours above ground. 

From an attentive consideration of all the symptoms 
which attend this disease, and a strict examination of the 
putrid state, and dissolved gangrenescent condition in 
which we find the blood of those who labour under it; as 
well as the half- putrefied and mortified state in which the 
body is found immediately after their death: whether this 
fever proceeds from infectious miasmata, or it arises from 
the great heat of the air, and water, and the putrefaction of 
our fluids, &x. from thence, and is thereby indigenous to 
those countries which are situated within the torrid zone; 
or whatever is its procatarctic cause; it evidently appears 
from all the symptoms which attend it, as well as from 
their putrid effects, thsit a bilious putrefying diathesis, is 
actually introduced into the blood and all the circulating 
fluids of the body, whereby not only the first and second 
concoctions, or the chylification and sanguification of the 
blood are so disturbed, altered and changed, that all the 
humors, and particularly the bile, are by the rapid motion 
of the blood and greatly increased heat of the body, so in- 
quinated with a putrid bilious acrimony, which in a little 
time so attenuates and dissolves the texture of the blood, 
that it runs off by the various excretory passages, and the 
pores, but also errores loci fluidorum are produced, 
whence the brain is affected, and all animal functions so 
disturbed and altered, and the texture of the blood is so 
dissolved, that all the humors of the body are almost 
changed into a putrescent lethiferous ichor, (if not timely 
prevented) which must inevitably end in death. 

That the bile has a great, if not much the greatest share 
in producing this fever, and this putrid gangrenescent state 
of the blood, I think is too evident to be doubted; notwith- 



PECULIAR TO THE W. INDIA ISLANDS, &c. lis 

standing what a late ingenious author* has said to the con- 
trary: for it is well known, that the bile will putrefy both 
much sooner, and to a much higher degree of acrimony, 
than any other humor in all the human body, and also will 
dissolve the texture of the blood much sooner: and we 
not only observe that a great quantity of deep yellow and 
almost black, putrescent, acrid bile, is constantly dischar- 
ged both upwards and downwards, even from the first be- 
ginning of this disease; and the suffusion of it all over the 
body afterwards, confirms the same; and we also find upon 
opening the bodies of those who die of it, that the gall- 
bladder, and its ducts, are always found turgid with a por- 
raceous, blackish, putrescent bile; and we likewise ob- 
serve, that the hypochonders, especially the right, and the 
adjoining prsecordia, are the most affected throughout the 
whole time of the disease, which is the seat of the liver and 
gall-bladder; insomuch, that the same author says,f it 
seems to be the seat and throne of this disease. And I 
have always observed, that the sick cannot bear the least 
pressure of one's hand, upon the parts where the gall-blad- 
der and biliary ducts and the liver are situated. 

No doubt but when the blood is once inquinated by this 
putrescent bilious humor, that the great relaxation of the 
solids, and the great diminution of the momentum of the 
fluids, subsequent to and arising from thence, and which 
generally comes on in the third day, or soon after, with the 
second state of the disease, does greatly contribute to pro- 
duce the putrescent diathesis, and increase that gangre- 
nescent disposition of the fluids and solids, which always 
attends the latter stage of this disease. 

From all the above-mentioned symptoms, and from the 
nature, disposition, and state of the humors, which are 
consequential to them, we must endeavour to deduce our 
indications and intentions of cure; since we have none of 
the ancients to follow, or to direct us, nor yet to appeal 
to; as none of them has ever mentioned, or probably ever 
seen this disease; neither have I seen any modern author, 

* Dr. Warren on this fever. f Idem ibid. 

p 



114 DISEASES, ACUTE AND CHRONICAL, 

except the above-quoted author, from whom I must beg 
leave to dissent, because I cannot think as he does; where- 
fore I drew up the following intentions of cure, which 
are, 

First, To moderate the too great and rapid motion of 
the fluids, and abate the too great heat and violence of the 
fever, in the two first days of the disease, as safely and as 
much as we can. 

Secondly. To evacuate and carry out of the body, as 
much of that putrid bile and those pittrid humors, as ex- 
peditiously and as safely as we possibly can. And, 

Thirdly. To put a stop to the putrescent disposition of 
the fluids, and prevent the gangrenes from coming on, by 
suitable antiseptics. 

For it is observed, that most, if not all, who die of this 
disease, generally have, and die of, mortifications, either 
internally or externally, or both. 

And as this fever and most of its symptoms, are gene- 
rally great and violent, and the pulse very quick and full, 
the heat of the patient is most commonly very great; since 
heat or m l^ fire, is always collected in proportion to the 
quantity of matter, multiplied by its quantity of motion, or 
as the momentum of the circulating fluids is; and this be- 
ing very great, consequently the first intention of cure, 
viz. To moderate the too great and rapid motion of the 
fluids, and abate the heat and violence of the fever, in the 
two first days of the disease, is indicated, and is absolute- 
ly necessary: and as it is well known to physicians, and 
may be demonstrated by hydraulic laws, that by lessen- 
ing the quantity of the blood, we diminish its motion, and 
consequently abate the violence of the heat and fever: 
wherefore bleeding, in the beginning of the first stage of 
this fever, either to a greater or less quantity, accordingly 
as the following symptoms and circumstances indicate, is 
always absolutely necessary: and the quantity to be taken 
away should always be as the age and strength of the pa- 
tient, the degree of the plethora, and the greater or less 
elastic state of his solids, the fullness of his pulse, and the 
violence of the fever and its symptoms. For which rea- 
sons, when I have been called in time (which is too seldom 



PECULIAR TO THE W. INDIA ISLANDS, &c. 115 

the case) I generally order twelve, fourteen, sixteen, eigh- 
teen, or twenty ounces of blood to be taken away, on the 
first or second day; but always as the above-mentioned 
symptoms and rules indicate and direct: and if the patient's 
pulse rises after the first bleeding, or if the fever continue 
to be still high, and the pulse full, (for it is never hard in 
this fever) I repeat the bleeding once, in the first or se- 
cond day of the disease, if the above-mentioned symptoms 
indicate" it; but bleeding a third time is seldom or never 
required, neither is bleeding on the third day almost ever 
required; and when it is performed on that day, it ought 
not to be advised without great caution and judgment; 
neither should a vein be opened after the third day in this 
fever, unless some very extraordinary symptoms and cir- 
cumstances require it, which very rarely or never happen: 
because the pulse generally sinks to be low on that day, 
or very soon after it, when bleeding must be greatly pre- 
judicial, as the blood is then in a dissolved state, and the 
pulse sunk low, which it now must sink lower, by dimin- 
ishing the momentum of the fluids, and consequently in- 
crease their gangrenescent disposition, and so bring on a 
mortification and death. (59) These probably were the 
reasons .why the before- mentioned author* advised not to 
bleed at all in this fever; but as the pulse is generally so 
exceeding quick and full, and the heat and violence of the 
fever so great in the two or three first days of it, it is ab- 
solutely necessary to abate and moderate them, by taking 
some blood away in those days, otherwise that violent heat 
and rapid motion of the blood, arising from that putres- 
cent bilious acrimony, so attenuates and dissolves it, that 
it brings on more fatal consequences much sooner, as I 
have more than once or twice observed; and I have always 
found that taking away a moderate, but sufficient quantity 

(59) The editor concurs with the author, in dissuading from 
the use of the lancet, for the first time, after the third day, in 
this fever; especially where no depleting remedies have been 
previously used. 

* Dr. Warren on this fever. 



i 16 DISEASES, ACUTE AND CHRONICAL, 

of blood on the first or second days has rendered the fie* 
ver more moderate, and abated the putrescent diathesis 
afterwards: but as to the quantity of blood to be taken 
away in this case, either the first or second time, or on the 
first or second days, it is impossible to ascertain it, since 
that must be different in different patients; because some 
constitutions can better bear the loss of fifty ounces of 
blood, than others can the loss of eight or ten; therefore 
the only rules that can be given, are those laid down 
before. 

After bleeding, we come to the second intention of 
cure; which is, to evacuate and carry off as much of the 
bilious putrid humors, as soon and as safely as we can. 

The great irritation of the stomach, by the putrid bi- 
lious humors which constantly attend this fever, with al- 
most continual Teachings and violent vomitings, seem to 
indicate giving an emetic; but the coats of the stomach, I 
have always observed, are here so violently stimulated and 
irritated, and most commonly inflamed by the acrimony of 
the putrescent bile, that any emetic, even the most gen- 
tle, and mild, and small dose, generally brings on such an 
incessant vomiting, that it continues in spite of all reme- 
dies, till an inflammation and mortification of the stomach 
comes on, which soon ends in death; as I have too often 
observed, when called in after they have been given: nei- 
ther could I ever find that any antiemetics, fomentations, 
or any other methods, would very seldom avail and pre- 
vent it. Wherefore I have always strictly forbid giving 
any emetics whatever. (60) 

But as the carrying off those putrid bilious humors, be- 
fore their putrid acrimony is too much increased by the 
heat of the fever, or is carried into the blood, is so abso- 
lutely necessary; I usually order the patients to drink large 
draughts of warm water, to which 1 sometimes add a lit- 
tle simple oximel, or a little small green tea, in order to 

(60) There are cases in which an extraordinary degree of 
torpor in the stomach and liver has rendered an emetic useful 
in the first stage of the yellow fever. The editor employed them 
in several instances, in the yellow fever of 1798 5 with advan- 
tage, 



PECULIAR TO THE W. INDIA ISLANDS, &c. 117 

carry ofF those putrid humors; and they are most com- 
monly very copiously discharged by this means, and the 
patient much relieved thereby, as I have often with plea- 
sure observed. For here no additional stimulus to the 
coats of the stomach, is necessary to excite vomiting, that 
being already too great; and the warm water, being a 
smooth emollient, acts as a fotous to the stomach, and so 
contributes to prevent those bad consequences before- 
mentioned from coming on.(61) 

And after the patient has by this means vomited seven, 
eight, or nine times, and discharged a good deal of yellow 
and blackish bilious matter, as they generally do, and the 
stomach is very well cleansed; in order to gain a truce 
and some respite from their anxiety, and almost continual 
reaching, vomiting, and sickness, which are not increas- 
ed, but somewhat relieved by drinking the warm water, 
I usually give extract, thebaic, gr. i. vel gr. iss, and or- 
der them to take nothing into their stomachs for two 
hours after it, that they may retain it; and it being in so 
small a compass, they scarce ever reject it. By this 
method, the poor distressed patient gets some rest and 
respite, and all the symptoms are generally considerably 
abated, the reaching and vomiting either totally cease, or 
do but seldom return; so that other medicines may be 
given and retained on the stomach, which it could not re- 
tain before; such as cooling acid juleps, or other antiphlo- 
gistic and antiseptic medicines; but neither nitre, nor any 
preparations of it, will rarely either agree with or stay on 
their stomachs, or if they or the common saline draughts, 
though esteemed antiemetics, do chance to stay with 
them, which they seldom do, yet as attenuants they ought 
rather to be ranked among the ledentia in this disease, 

(61) This mode of washing the stomach with warm water, 
when the vomiting attends the first stage of this fever, is strong- 
ly recommended, not only by experience, but by reason. It 
evacuates morbid matter, blunts acrimony, lessens the pain of 
vomiting, and safely wears away the morbid excitement and 
irritability of the stomach; and thus prepares it to be benefitted 
by the opiate, which the author advises afterwards. 



118 DISEASES, ACUTE AND CHRONICAL, 

however useful they may be, and often are, in most in- 
flammatory and some other diseases. 

And if the patient has not a stool or two after drinking 
the warm water and vomiting, it is necessary to give a 
gentle purging clyster soon after the vomiting, and be- 
fore the opiate begins to affect the patient, to evacuate 
the excrement, and as much of the putrid bilious humors 
as we can: and after six or eight hours rest and respite, I 
order a gentle antiphlogistic and antiseptic purge to be 
given; in order to carry as much more of those putrid 
bilious humors off' as we possibly can. Or if the patient 
has a purging before, which sometimes though very sel- 
dom happens, I order a gentle dose of toasted rhubarb 
to be given(62) and an antiseptic anodyne after it has 
operated, to abate and check the too much purging, but 
not to stop it; as I have always observed it to be of service 
in this case, provided that it is moderate and not too 
violent: and 1 observed that all those who had this pur- 
ging, generally did well with it, if the patient's strength 
was but properly supported with suitable nourishment, 
and proper antiseptic medicines; which last are always 
absolutely necessary, in this fever. 

And though purging in many other fevers, except the 
second fever of small-pox, in the pleuritis and peripneu- 
monia notha, and in a few other fevers, may be deemed 
bad practice; yet in this fever, as nature indicated it, I 
have always found it of singular service, and the patient 
not only greatly relieved by it, but the disease always 
rendered more moderate, and manageable afterwards: 
wherefore whenever a painful burning heat in the hypo- 
chonders, or about the prascordia, comes on, I generally 
give a little manna and tamarinds, which seldom or never 
fails to carry off a good deal of putrid bilious matter, 
and that burning pain which it causes, with it; wherefore 



(62) The purging induced by nature, in this disease, some- 
times imposes upon a physician. It is oiten from the lower bow- 
els only. Purges should be given in such cases, in order to 
cleanse the small intestines, in which acrid bile, when suffered 
to stagnate, often does great mischief. 



PECULIAR TO THE W. INDIA ISLANDS, &c. 119 

I generally repeat this purging, whenever that burning 
pain returns and indicates it, and with all the success we 
can desire. 

I have observed before, p. 109, that this fever greatly 
abates, the pulse sinks very much and becomes low, and 
the heat of the body becomes moderate on the third day; 
though the other bad symptoms continue, and sometimes 
grow worse, and a coma comes on, with a great yellow- 
ness diffused all over the skin, which with the before- 
mentioned symptoms, p. 108, are the distinguishing cha- 
racteristics of this disease. This extraordinary change in 
the fever, from being very hot and high, and the pulse 
very rapid and full, though soft, to become very small 
and low, and the patients skin which was burning hot be- 
fore, to become little warmer than when in health, and 
sometimes colder, with a coma and all the other bad 
symptoms as above, at the same time, is such a change, 
as requires a very different method of treatment, from 
what it did in the first two or three days of the disease. 

For now every symptom and circumstance evidently 
shew, that a dissolution, of the globules and texture of 
the blood, and a putrescent, colliquative, gangrenescent 
state of the fluids, now hasten on apace, with all their 
fatal symptoms. Hence the third and last intention of 
cure evidently appears, viz. To put a stop to the putre- 
scent diathesis of the fluids, and prevent the gangrenes 
from coming on. 

In these circumstances it is absolutely necessary, that 
vis vitae, and the momentum of the circulating fluids, be 
increased and kept up in a moderate brisk state; and the 
most effectual antiseptics given, to put a stop to the pu- 
trescent disposition of the fluids or gangrenes will come 
on. 

In these circumstances the cortex, peruv. mav be 
thought to be the best, and most likely medicine to suc- 
ceed: I grant that its well known efficacy, in preventing or 
putting a stop to mortifications, promises much; but the 
misfortune is, that this drug is so disagreeable to most 
palates, and the stomachs oif the sick in this disease are 



120 DISEASES, ACUTE AND CHRONICAL, 

so much affected, and so weak, and so subject to reject 
every thing, even the most pleasant and innocent, that they 
can very rarely take it in any shape, and still much fewer 
can retain it when they have got it down; so that no stress 
or dependance can be laid on it: and the only way that I 
could get a patient to take and retain two doses of the 
bark in this case, was the extract of it, with a spoon- 
full or two of milk and water, and even thus they could 
not retain a third dose of it; wherefore I soon laid aside 
all future attempts to give it, foreseeing that it would be 
in vain, and that we should thereby only lose time, not to 
be recovered, and our patients also, when we might pro- 
bably save them by another method; and I am told that 
several others have tried to give the bark in this case, but 
with no better success. 

The radix serpentaria virginiana, is the next best an- 
tiseptic, whose extraordinary effects in stopping the pro- 
gress of gangrenes, has been known for many years; 
wherefore I tried it mixed with some others in the fol- 
lowing manner, and with much better success than I 
could hope for, or durst expect: for I found that a light 
infusion of this root, not only sat easily on their stomachs, 
but it moderately raised the pulse and fever, which were 
now sunk too low, and kept them in an equal moderate 
state, if prudently given, which is a thing of the greatest 
importance at this time of the fever, as on that chiefly 
depends the recovery of the patient, therefore should be 
diligently attended to by the attending physician; and as 
soon as ever he perceives that the pulse begins to abate 
and sink lower, either on the third day, or sooner, he 
must immediately begin to give the antiseptic and warmer 
medicines, to support the vis vitas. I have found the fol- 
lowing form both the most agreeable to their weak sto- 
mach, and the most powerful antiseptic, and indeed the 
piost successful medicine. 

I$> Rad. serpent, virg. Si]- croci Angl. 5ss. m. et in- 
land, vase clauso in aq. bul. q. s. per horam unam ut 
col. §vi. adde aq. menthze simp. gij. vini maderiens. §iv. 
syr. croci. vel syr. e mecon. %u elix. vitrioli acid. gut. 



PECULIAR TO THE W. INDIA ISLANDS, &c. 121 

q. s. ad gratam acidior. Saporem; m. exhibe cochl. 
duo vel tria singulis horis vel bihoris, vel ssepius pro 
re nata.(63) 

This very rarely fails to sit light and easily on their 
stomachs, even when the saline antiemetic mixtures will 
not-, and often when every thing else is rejected. By 
the use of this and proper nourishment, taken in small 
quantities, and often, (for when it is given in larger 
quantities, the stomach too often rejects it, and the 
patients sink for want of support;) and their food or 
whey should now be made a little stronger of the wine 
than before, or than usual in other fevers: by this meth- 
od the pulse is raised, and usually kept, and the fever 
rendered moderate, and the coma and other bad symp- 
toms greatly abated, and the patient usually goes on well. 
But if after taking this a little while, we find that the pulse 
does not rise, and the heat become equal all over the 
body, and moderate; but on the contrary, a coldness of the „ 
extreme parts comes on, and increases, these medicines 
must be made more warming, either by increasing the 
quantity of the rad. serpent, and saffron, or by adding 
vinum croceum, or confec. cardiac, or some such like 
medicines, till the pulse is raised, and the heat equally 
expanded all over the body; and then the fever may be 
kept in a moderate state, by giving the before- mentioned 
antiseptic julep, or such like medicine: but not by the 
use of volatile alkaline salts, or spirits, as sal. et spir. 
c. c. salis ammoniac, vol. spir. vol. aromat. &c. which dis- 
solve and increase the putrescent state of the animal flu- 
ids, as is well known both by observation and experi- 
ments, not made on pieces of dead flesh, or dead stag- 
nating animal fluids; but by giving these alkaline volatile 

(63) The editor has seen the most beneficial effects from the 
use of an infusion of Virginia snake-root, in composing the 
stomach, in all the grades of bilious fever, after sufficient deple- 
tion. He first saw its good effects in the yellow lever which 
prevailed in Philadelphia in the year 1762, prescribed by the 
editor's preceptor in medicine, Dr. John Redman, 



122 DISEASES, ACUTE AND CHRONICAL, 

salts and spirits to the living, which when they are taken 
into and mixed with the circulating blood, do greatly 
attenuate and dissolve it, and with the heat of the body 
do bring on a putrescent diathesis, and a putrid colliqua- 
tion of the fluids, and consequently must be greatly 
prejudicial in this fever, ifhich arises from a putrescent 
bilious acrimony, and wherein the fluids are already really 
in a dissolved putrid gangrenescent state: whereas the 
rad. serpent, crocus, & elix. vitrioli, are very powerful 
antiseptics, and prevent the dissolution and putrefaction 
of the blood; and consequently prevent or stop the hae- 
morrhages also which usually come on in this second 
state of the disease. 

It may be expected that the low pulse, coma, delirium, 
and the coldness of the extreme parts, with the tremors 
and convulsive spasms, &c. should induce me to think 
that vesicatories are indicated, and that I should both use 
and advise them. I allow that they seem at the first view 
to be indicated, but a further inquiry into the cause and 
nature of these symptoms, and a due consideration of 
the dissolved colliquative state which the fluids are in in 
this fever; and an examination into the effects of the al- 
kaline salts of the cantharides, when carried into our 
blood, will clearly demonstrate and sufficiently convince 
us of the contrary: for this coma, low pulse, coldness 
of the extreme parts, delirium, tremors, and the other 
bad symptoms attending this fever, do not proceed from 
a lentor and viscidity of the circulating fluids, as in some 
other fevers, as the slow nervous fever, and some others; 
but from a dissolution of the red globules of the blood, 
and their being carried into such small vessels as do not 
naturally admit them, whence an error loci fluidorum in 
cerebro, Sec. is produced, and a due secretion of the ner- 
vous and other fine fluids, or animal spirits in the brain, 
is obstructed or hindered, and a diminished momentum 
of the blood, the consequence of the former, at the same 
time: the application of vesicatories must increase all 
these, and render very bad, much worse. But in other 
fevers, where these symptoms arise from a lentor and 
viscidity of the fluids, which retard and hinder their free 



PECULIAR TO THE W. INDL1 ISLANDS, &c. 123 

circulation, and due secretion; blisters being applied, the 
salts of the cantharides pass into the circulating fluids, a$ 
the stranguries and increased motion of the blood de- 
monstrate, and attenuate, and dissolve that lentor and vis- 
cidity, and so remove the cause of those symptoms, and 
produce almost surprising good effects, as we often see 
when they are judiciously applied, in such cases. For 
the same reasons, the application of vesicatories in this 
fever, must dissolve the blood more, which was in a dis- 
solved putrid state before, and render the disease and all 
its symptoms worse. 

The truth of this is confirmed by observation and 
experience: but such is the unreasonable fondness of 
blisters, in this island, and in some other countries also, 
almost in every case where pain and a fever seize, that 
they are too often applied even in dysenteries, and in the 
beginning of inflammatory fevers, and much too often 
in this fever, even in the last state of it, to the great pre- 
judice of their patients: there are some few who practise 
there who know better, but in general from the want of 
reading such authors as would inform them better, they 
ignorantly follow the practice of their fathers and masters, 
who read very little; and themselves read less, and follow 
custom, which has rendered the use of blistering almost 
sacred, and the fear of reproach for not using them al- 
most unavoidable, if the practitioners have not fortitude 
and judgment sufficient to oppose this their unwarrant- 
able and pernicious use. 

This has but too often given me an opportunity of 
seeing their bad effects, especially in this fever; where 
I have observed, that the coma, tremors, subsultus tendi- 
num, the coldness of the extreme parts, and the low 
pulse, though (this sometimes has been rendered a little 
quicker, but not more full) have not only not been relieved 
by their application, but have been increased thereby, 
and the haemorrhage, which usually attends this fever, 
has been hastened on, or if come on before, it has been 
increased by their application: and I have seen a vesica- 
tory, which I ordered to be taken off, as I usually do 
as soon as I come in this fever, that the part where it 



124 DISEASES, ACUTE AND CHRONICAL, 

laid was turned black and perfectly sphacelated, and if 
the spine and ends of the ribs had not hindered, a large 
square passage into the cavity of the thorax would have 
been opened, if the patient had lived a few hours after it, 
but he died two hours after I came. And the reflection, 
that I have never ordered any vesicatories to be applied 
in this fever, and have always strictly forbidden their ap- 
plication in it, I must say, gives me great satisfaction. (64) 
But let us return to that method of treating this dis- 
ease, which not only seems to be the most rational, but 
has been found to be the most successful; though it may be 
almost of as much service, to remark the ledentia, as to 
mention the adjuvantia. As the disease advances, the pu- 
trescent state of the fluids increases, if not prevented by 
the use of antiseptic medicines, and observing carefully to 
keep the fever in a moderate state, and that it neither rise 
too high, as it often does in the two or three first days of 
the disease, nor on the contrary sink too low, as it fre- 
quently is very subject to be, in the second state of the 
disease, and in which there is the greatest danger: where- 
fore, whenever the fever begins to sink too low, we must 
endeavour to keep it up in a moderate state; by giving 
something of the nature of the before- mentioned antisep- 
tic julep, which may be made more warming when neces- 
sary. And if the anxiety, with the burning pain and a 
tenseness of the prascordia and hypochonder return, either 
alone, or with the coma, or a delirium accompanying it, as 
is too often the case, and always arises from an increase 
or collection of those putrid bilious humors, they must be 
carried off by repeating the antiseptic purge, as before ; 

» '■ . _ , ■ i i . , n . i ■ ■ i i . i ■ i i . 

(64) Our author's objections to the use of blisters, in the ear- 
ly and last stages of this lever, are well founded. In both states 
oi the disease they often induce gangrene, especially when they 
are applied to the extremities of the body. There is a precise 
point, ;n the course oi this fever, before and after which blisters 
should not be applied. There is but one exception to this rule, 
and that is, where it is necessary to arrest the tendency of the 
whole force of the disease to the brain or stomach, by a revul- 
sive action upon the skin. 



PECULIAR TO THE W. INDIA ISLANDS, &c. 125 

and the following form is what I have always found to 
agree the best with most patients, and seldom fails to re* 
move these bad symptoms. 

§> Mannse calab. gtss. vel gii. tamerind. cond. §i. tart, 
vitriolat. gr. x. m. solv. in sero lactis vino maderiens. 
praeparat 3vi. et cola, adde tinct. sense, gss. misce, divi- 
det. in tres vel quatuor partes, de quibus capiat seger 
unam omni hora, donee incipiat purgare. 

This may be made stronger or weaker, as the strength 
of the sick requires; and it seldom fails to carry off a quan- 
tity of yellow and blackish putrid bilious matter, by which 
the patient is much relieved, and the above-mentioned bad 
symptoms are either much abated, or totally removed. 

And I most commonly find it necessary to repeat this 
purging every second or third day, for two or three times; 
and sometimes, when the symptoms are very bad, and 
have not much abated upon taking the first and second 
purge, and the patient has not been treated in the method 
before described, or I have not been called in, till late in 
the disease, I have found it necessary to repeat the gentle 
purging every day, for four or five days successively, and 
with the desired success too. But when I have been called 
in at the beginning of the disease, and treated the patient 
in the method before described, the repetition of the pur- 
ging, is very seldom required more than twice or three 
times at most, in the whole course of the disease ; especi- 
ally if the antiseptic medicines have been sufficiently ta- 
ken in the intervals between the purging during the whole 
time of the second state of the disease; this method rarely 
fails to succeed. 

This method has been, and may probably be thought 
by some others, too simple and easy, to conquer so vio- 
lent and formidable a disease: what ! only bleed once or 
twice, and give a little warm water, and two or three sim- 
ple purges, and this simple julep, to subdue such a terri- 
ble disease! without any fine boluses, cordial volatiles, and 
vesicatories ! but I must tell such persons, that the more 
simple the method is, if it be but judiciously and fitly 
adapted to the nature and cause of the disease, it is so 
much the better, because, contraria contrariis medentun 



126 DISEASES, ACUTE AND CHRONICAL, 

And I flatter myself that the learned and judicious, will 
think so with me, especially when they duly consider, that 
the first and principal seat of this disease, is in the hypo- 
chonders, especially the right, where the liver and biliary 
ducts are seated; and that the bile, of all the humors in 
the body, does the most readily putresce, and that to the 
highest degree of acrimony; and that this putrid acri- 
monious bile is, at least some part of it, carried into 
the blood; where its putrescent acrimony is greatly 
increased, by the great heat of the fever; and as the 
bile is a liquid animal soap, whose property is to dissolve 
all such bodies as are soluble by it, especially the animal 
fluids, and this dissolving property being now greatly 
heightened and increased by its putrid acrimony, 
more readily dissolves the red globules of the blood, if 
not those of the serum and the finer fluids also: and the 
blood being thus dissolved; and that dissolution being still 
heightened and increased by the heat of the air, and the 
fever, the whole mass of the cruor is soon brought into a 
putrid, colliquative, gangrenescent state, and the dissolved 
red globules are carried into such small serous, lympha- 
tic, or still smaller vessels, as do not naturally admit them, 
whence the brain is affected, and the coma, tremors, con- 
vulsions, and ail the other symptoms attending this dis- 
ease are produced; as also the haemorrhages, and the blood 
flowing through all or most of the excretory ducts, from 
its being so dissolved; also a deep yellowness suffused all 
over the body, with many livid spots, and mortifications 
in various parts of it; all which arise from the putrescent 
bile, and are produced in this manner. 

This being the cause, and this the manner of producing 
this fever, and all its symptoms; a just method of rea- 
soning from them makes it evidently appear, that this 
method of moderate bleeding and giving cooling acids, 
in the two or three first days of the fever, to prevent its 
being too violent, as it often is, yet being careful not to 
bleed too much, lest it sink the patient and his pulse too 
much after in the second state of it; and evacuating and 
carrying off as much of the putrid bilious humors, both by 
the warm water at the first, and by purging after; and then 



PECULIAR TO THE W. INDIA ISLANDS, &c. 127 

giving the best antiseptic medicines that the patients can 
take, in a liberal manner, as before mentioned, to prevent 
the haemorrhages and gangrenes from coming on; not 
only appeared to be the most rational, and the most ju- 
dicious, but I found this method to be much more suc- 
cessful, than more pompous medicines, or the methods 
generally used. 

For as I found that all the methods of treating this fe- 
ver, which had been used both in this, and the other islands, 
were very uncertain, and too often unsuccessful; it indu- 
ced me carefully to observe, and attentively to inquire 
into the cause and nature of this fever, and ail its symp- 
toms, and the above method of reasoning first dictated 
to me this method of treating it, not long after I came 
here, and induced me to try it, the first opportunity I 
should have, as it appeared to be more rational than 
any of the others. And an opportunity soon offered, 
which I shall beg the reader's patience, to relate, as it 
proved so successful. 

A young man about twenty-four years of age, surgeon 
to a Guinea ship, was brought into a house where I was 
visiting a patient; he was of a sanguine, robust consti- 
titution, and a lover of spirituous liquors, and had been 
drunk three days and nights successively, and in that 
condition had run several races on the hot sea shore, 
near noon, with the sailors, in the heat of the sun, and to 
complete his folly, laid the last night after that exercise, 
in the open air under a tamarind- tree all the night, where 
he was seized in the morning with all the symptoms of 
this fever, in the most violent manner that I have ever 
seen any one; in this condition he was brought to the 
house where I was: his reaching and vomiting were so 
incessant, that he could not get time to say yes, or no, 
to the questions which I asked, without watting some 
time for it, each time; his eyes were red and inflamed, at- 
tended with a burning heat, as usual in the beginning of 
this fever, and he had all the other symptoms which at- 
tend the first attack of this fever, in the most violent 
manner, which I need not repeat. I ordered Jxvi. of 
blood to be taken from him, which was very florid, thin, 



128 DISEASES, ACtJTE AtfD CHRONICAL, 

and much dissolved, and then directed him to drink 
warm water freely, and to vomit eight or ten times; and 
after that to take extract, thebaic, gr. jss. and take 
nothing for two hours after it; but I being gone, and he 
finding that he vomited with more ease, less sickness 
and reaching, with the warm water, than he did before, 
and being much alarmed at his having this fever, he 
drank three gallons of the water, and brought up great 
quantities of yellow and blackish bilious matter with it, 
and washed his stomach effectually. He then took the 
extr. thebaic, and slept three or four hours after it; and 
the vomiting ceased: he took some panada, and four 
hours after that, the purge of manna and tamarinds, &c. 
which gave him eight stools, and carried a good deal 
more of the putrid bilious matter off downwards; and 
got some rest after it: he then took of an antiseptic julep 
often, and light nourishment a little acid, at the intervals; 
and repeated the purge on the third day, as directed. I 
being called out of the town, I did not see him till the 
fourth morning after; he said that he had followed my 
directions, and I found him free from the fever and all its 
symptoms, but weak and low, and his skin a little yellow, 
but much less so than usual, unless when the bilious 
matter is thus carried off. I ordered him to take elix. 
vitrioli acid. gut. lx. three or four times a day for a few 
days, in an infusion of mint leaves with a little snake 
root, made as tea which he did; and soon recovered per- 
fectly well, in seven or eight days time. 

This patient being seized in so violent a manner, and 
recovering in so short a time, and so near to the rule 
which the elegant Celsus recommends, cito, tuto, et jucu- 
de, not only confirmed the above manner of reasoning 
on the cause and nature of this disease to be right, but 
made me determine to follow the same method as near as 
I possibly could ever since, and I must add with the 
same good success also, when I am called so early on in 
the disease that I can strictly pursue it: which is too 
seldom the case; for in general the physician is not called 
in till the fourth or fifth day, or after, when the putrid acrid 
bilious matter is a great part of it carried into the blood. 



PECULIAR TO THE W. INDIA ISLANDS, &c. 129 

which it has so dissolved and brought its whole mass in- 
to a colliquated, putrid, gangrenescent state, that the best 
of methods, and the most efficacious medicines, how r ever 
judiciously timed and applied, are precarious and uncer- 
tain; or sometimes it is so far advanced, that the ablest 
physician can do no more than tell the relations of the sick, 
that it is too late, and that they can live but a few hours: 
for I know no disease In which the recovery of the pa- 
tient, so much depends upon the right or wrong method of 
treating it, at the very first attack or beginning of the dis- 
ease, as this fever does: for by thus discharging and carry- 
ing the putrid, acrimonious, bilious matter out of the bo- 
dy, before much of it is carried into the blood, not only 
most of the bad symptoms which attend the second state 
of the fever are prevented from coming, but the haemorr- 
hages, and the yellowness of the skin, &c. also, and 
the fever soon taken off too; for I have never seen any 
haemorrhage come on, and but little yellowness, or in 
some none, when they were thus treated. 

And when the last stage of the fever is come on before 
we are called in, provided that it is not at the very latter 
end of it, I have always found that this method of 
gentle purging, whenever the before-mentioned symp- 
toms indicate it, and a liberal use of the antiseptic med- 
icines in the intervals has been so successful, that I have 
seen but two patients that have died in this fever during 
the eight years past, in which I treated in this manner; 
and one of them was so weak that he could not take a 
spoon-full of any thing, and so near his end, that he died 
about two hours after without taking any medicine; and 
the other killed himself by drinking a gallon of cold wa- 
ter, in less than three hours time, (after taking half an 
ounce of manna in the morning) which struck such a 
coldness into his whole body that he died; though I have 
visited several every year,* and in some years a great 
many: therefore I take the liberty of recommending this 
method to others, and wish it to be as successful to all. 

I have said little of the dietetic part of cure in this dis- 
ease, though it is necessary to say something, especially 
as their stomachs are generally so very weak, and so 



130 DISEASES, ACUTE AND CHRONICAL, 

much irritated by the acrid bile, that they almost reject 
every thing, and can often retain but very little. It may 
be said, that their diet must be thin, light, and little; but 
these qualities alone are not sufficient in this disease, for 
it must be made as pleasant and palatable as possible, in 
the three first days of it; and as much antiseptic as possi- 
ble, to be made also agreeable, or otherwise they will nei- 
ther be able to take or retain it. As, §> Panis bene fer- 
mentati leviter cocti §iv. coq. in aq. pur. per horam, turn 
tere diu, dein preme per linteum densissimum ut sit li- 
quoris sic parat? ibiss. cui immisce limonii maturi taicola- 
tim scissi §i. nucis moscat. in polinem triti 5u servetur 
usui; sumat iEger omni bihori §ii. vel £iii. tempore usus 
admiscendo vini MaderiensisToet sacchari quantum placet 
Palato ^gri.(65) 

Or pearl barley may be boiled, and mixed in the same 
manner; also Madeira, or Rhenish wine-whey, and given 
often, and in small quantities, during the two or three first 
days of the fever. But after the third day, when the pulse 
begins to sink, and the fever is too low, it is absolutely ne- 
cessary that both the food and drink should be made more 
antiseptic, and more generous and warming by increasing 
the quantity of the wine in the panada, and the whey, es- 
pecially if the patient's pulse and the fever are too low; 
and if he has been accustomed to drink wine pretty free- 
ly; or if the fever be very low, and the patient be faint, I 
sometimes order him a glass of old hock, or old Madeira 
wine, alone, or sometimes mixed with a little water; and I 
find them to be much better cordials, than the hot spiritu- 
ous compound waters of the shops are, in this fever; and 
sometimes I order a beverage of water, lemon juice, su- 
gar, and Madeira wine, of which they drink a little and 
often, to assist the antiseptic medicines to raise the pulse,, 
and keep the fever in a moderate state. 

And we must now carefully avoid giving any thing, 
either as nourishment or in medicine, that is of a septic 



(65) The editor has prescribed this drink, with advantage, 
and has always found it very grateful to his patients, 



PECULIAR TO THE W. INDIA ISLANDS, &c. 13.1 

nature, or that has the least tendency to putresce; but on 
the contrary both diet and medicines should be as much of 
the antiseptic nature as they can be made, so as to make 
them suitable in all other respects; and that not only in this 
case, but in all other diseases the physician ought to take 
care that the diet of the sick be of the same disposition, 
and have the same tendency, as the medicines which he 
prescribes for them have; for if they are of contrary na- 
tures, and have opposite effects, they will do little service, 
and but seldom be attended with success, how good and 
efficacious soever the medicines may be; since the quan- 
tity of the first taken into the body, and mixed with our 
circulating fluids, in all cases so far exceeds the quantity 
of the last, that if they are of opposite and contrary natures, 
they must at best only destroy each other, and conse- 
quently the medicines can have but little effect. This, I 
think, is a material thing, which 1 think is but too much 
neglected in practice, at least by some, wherefore I take 
the liberty to mention it here. 



132 DISEASES, ACUTE AND CHRONICAL, 



OF THE DRY GRIPES, OR DRY BELLYACHE, 



THIS colic is most commonly called the dry-gripes, 
and dry belly-ache, and is a most painful disease, which 
frequently seizes the inhabitants of the West-India islands, 
and the continent of America, and especially the strangers 
who come to reside there; and sometimes, though very 
rarely, some of the inhabitants in England, and some 
other parts of Europe: for I have seen several patients in 
this disease, when I resided at Bath, who never had been 
out of England, as also did Dr. Sydenham long before. I 
think that Riverius is the first that mentions it, and calls 
it colica Pictonum, the colic of Poictiers, a province in 
France, where it was first taken notice of. 

Those who have thin dry constitutions, and are much 
emaciated by excessive perspiration and sweating, or la- 
bour under great anxiety and affliction of mind, or are 
immoderate drinkers of spirituous liquors, especially such 
as are fiery and new; or those who are very irregular in 
the use of the six non-naturals, and especially those who 
live in America, and the West- India islands, are the most 
subject to this cruel disease; to which countries it seems 
to be endemial. 

It generally seizes the patient with an acute pain at the 
pit of the stomach, which extends itself down with gri- 
ping pains to the bowels, which are soon after much dis- 
tended with wind, with frequent Teachings to vomit ? 






PECULIAR TO THE W. INDIA ISLANDS, &c. 133 

which sometimes bring up small quantities of bile and 
phlegm. An obstinate costiveness, yet sometimes attend- 
ed with a tenesmus, and the bowels seem to the patient as 
if they were drawn up towards the back, at other times 
they are drawn into hard lumps, or hard rolls, which are 
plainly perceptible to the hand on the belly, by strong 
convulsive spasms: and sometimes the coats of the intes- 
tines seem to be contracted and drawn up from the anus, 
and down from the pilorus, towards the part first and most 
affected near the navel, as to the centre of their misery: 
the faeces, when they are discharged afterwards, are in lit- 
tle hard dry lumps like bullets ; the belly usually continues 
most obstinately costive, and the patient discharges but 
little urine, and that often with pain and much difficulty. 
The pulse is generally low, though often a little quicker 
from the acute pain, but no fever, nor any symptoms of 
an inflammation of the parts affected, either perceptible by 
the pulse, or any other symptoms; though one year I saw 
two or three patients in this disease, who had some in- 
flammatory symptoms, and their blood was a little sizy, 
when inflammatory fevers were epidemical, and they pro- 
bably had got a little cold just before; but this very rarely 
happens.* The extreme parts of the body are often cold, 
and sometimes the violence of the pain causes cold clammy 
sweats, and faintings: their mind is generally much affect- 
ed, and their spirits sunk very low. And when this distem- 
per has been improperly treated, this state of costiveness, 
pain, and misery has continued twenty or thirty days, and 
sometimes longer; for I remember a case which being thus 
treated in a wrong manner, the patient continued, with 
some small intervals of being something easier, in this 
painful condition for six months, or more, and then reco- 
vered by a different method of treatment, in one week's 
time. When the sick fall into the hands of those who 
treat them in this wrong manner, the pain continues to be 
very violent, and at times almost intolerable, and that for 



^ * See the foregoing observations on the air, and epidemical 
diseases. 



134 DISEASES, ACUTE AND CHRONICAL, 

a long time; and then the patient's breath commonly ac- 
quires a strong, foetid, stercoraceous smell like excre- 
ments, from a long retention of the feces, and an absorp- 
tion of the putrid effluvia from them into the lacteals, by 
the strong convulsive contractions of the guts: and when 
the pain in the bowels has continued long, and at last be- 
gins to abate, a pain in the shoulder-points, and adjoining 
muscles, comes on, with an unusual sensation and ting- 
ling along the spinal marrow; which soon after extends it- 
self from thence to the nerves of the arms and legs, and 
they become weak, and that weakness increases till those 
extreme parts become paralytic, with a total loss of mo- 
tion, though a benumbed sensation often remains. 

The subtle cause of this disease, is sometimes carried 
by a sudden metastasis of it to the brain, and produces a 
stupor, or a delirium; and soon after the whole nervous 
system is so aifected, as to produce strong convulsions, 
which too often are followed by death. At other times, the 
violence of the pain reverts the peristaltic motion of the 
intestines, and violent vomitings, and all the symptoms of 
a misereri mei are produced, and the patient being exceed- 
ingly reduced by the long continuance of the violent pain, 
it is too frequently followed by the same fate.(66.) 

The cause of this disease will often lay still in the legs 
and arms, without giving the least sensation of pain, and 
sometimes is very suddenly translated from them to the 
bowels, or head; where it instantly produces the most vio- 
lent pain, and often fatal effects: and as this metastasis is 
so very sudden, it shews that the humor, or cause, is ex- 
ceeding subtle, as I have often observed; and I will beg 



(66) There cannot be a more correct history of the dry- 
gripes. It was a common disease in Philadelphia, between the 
years 1760 and 1770. It is now seldom to be met with except 
in painters. Its rare occurrence has been ascribed to the disuse 
of punch, and of late and heavy suppers; to the general use of 
flannel next to the skin; and to the abolition of porches, which af- 
forded a temptation to our citizens to expose themselves for 
several hours, in a state of inactivity, to the damp evening 
;ur. 



PECULIAR TO THE W. INDIA ISLANDS, &c. 135 

leave to relate a remarkable case, which I saw in a gentle- 
man when I lived at Bath. 

He had laboured under this painful disease some years 
in Maryland, which at last rendered his hands and arms 
paralytic; and they had continued in that useless state two 
years, without any pain in them all that time; he had no 
strength, and little motion, but a tolerable degree of numb 
sensation in them: and during these two years, he was 
pretty free from any pain in his bowels. He came to Bath, 
drank the waters, and bathed in them; and I suppose took 
proper medicines with them three or four months, and re- 
turned to London without any relief. The next spring he 
came to Bath again, and sent for me, and informed me 
how he had proceeded the season before; and then was so 
exceedingly uneasy at the loss of the use of his hands, and 
his not being able to write to his family, that he said he 
was determined to have the use of them restored if possi- 
ble, how dangerous soever the attempt might be: I told 
him, that if the cause or humor could be removed from 
his hands, it probably would return to his bowels with the 
same violent pain as before; or it might possibly be car- 
ried to his brain, with more fatal effects: he thought that 
was not possible, as it gave him no pain in his hands;, 
and said he was resolved that if I would not try to remove 
it, some other person should attempt it; who he was plea- 
sed to say, probably could not give him that assistance as 
he thought 1 could, if it did so; and insisted so strongly 
on my attempting to remove it from his hands, that at last 
I unwillingly assented to try: accordingly he had his hands 
and arms pumped at the hot-pump, then anointed with li- 
niment, saponac. mixed with some chemical oils, then 
wrapped up in flannel, in order to continue their sweating, 
and if possible to carry the morbid matter off that way; 
and to assist which, he took a draught with bals. peruv. 
gut. xxx. immediately after it: he slept well that night 
without any alteration, and repeated all the same method 
the night following, slept, and was easy till towards morn- 
ing, when he awakened with the most excruciating pain 
in his bowels, and his hands perfectly restored to their use 
and motion, as well as ever before. The pain in his bowels 



136 DISEASES, ACUTE AND CHRONICAL, 

was now so violent, that he desired the attendants to shoot 
him, or put an end to his misery any way. Though the 
morbid matter had laid in his hands, though on their 
nerves, for two years before, without giving the least sen- 
sation of pain; yet now being removed to his bowels, it 
gave him as great pain as ever before. In this condition I 
came to him, and presently gave him a draught with bals. 
peruv. gut. xl. philon. londin. 91. and in less than five 
minutes time, the pain was entirely removed from his 
bowels, and his hands became paralytic as before, in less 
than a minute's time, but without any pain in them. This 
metastasis was therefore produced by the bals. peruv. be- 
fore the opiate could act; and as the morbid matter was 
thus put in motion, I told him that we would try to carry 
it off, by only bathing his hands and arms in the warm 
bath- water every night, and sweating them in warm flan- 
nel after it, (without either pumping it on them, or using 
the liniment) and taking the bals. peruv. with a corrobora- 
ting bitter, in the Bath- water, which he did, and recover- 
ed the perfect use of his hands, without any return of the 
pain in his bowels, or elsewhere, in two or three weeks 
time.(67) 

Various methods of cure have been attempted and used 
in these parts of the world. As they were so costive, 
strong purgatives and clysters were much used, from the 
first appearance of this disease, almost down to this time; 
but all the strong drastic cathartics, (and the weaker were 
thought insufficient, as the stronger did not operate) do so 
irritate the stomach and intestines, and thereby increase 
the pain and the convulsive contractions and spasms of 
the guts, and rendered them more obstinate and worse; so 
that these medicines were generally either sooner or later 
rejected, almost without ever passing, and the clysters 
were mostly returned without having any effect, but that 
of increasing the spasms and pain: and if they chanced to 
pass, they so much increased the pain and convulsive 
spasms, that they either inverted the peristaltic motion of 



($7) This case strongly illustrates the utiity of disease. 



PECULIAR TO THE W. INDL\ ISLANDS, &c. 137 

the intestines, and brought on a misereri mei, or cast the 
morbific matter upon the brain, and produced strong con- 
vulsions; both which most commonly ended in death: or 
if the poor patient escaped with life, he lost the use of his 
limbs, and generally dragged on a miserable helpless life 
to the end of his days. This method was therefore justly 
exploded several years since, though I have known it pro- 
posed by a physician of some considerable practice; 
though in general the disease and its nature and cause, are 
now better known. 

The honest and worthy Dr. Sydenham treated this dis- 
ease (which is some chance times seen in England) with 
giving bals. peruv. a gut. xx. ad gut. xl. bis vel ter de die 
in pauco sacchari, and with much better success than the- 
method above, for this is a valuable medicine in this case. 

The ingenious Dr. Warren advises a method of treating 
this disease, which is more judicious, and better adapted 
to the nature and cure of it than either of them; and I 
think that some considerable improvements in the know- 
ledge of this disease, have been made both in its theory, 
as also in the practice, or manner of treating it, since his 
time. 

From the nature and symptoms of this disease, the 
strong convulsive contractions and spasms which attend 
it, without an inflammation or fever; and the sudden me- 
tastasis of its cause, from one part of the body to ano- 
ther, which sometimes happens; it plainly appears, that it 
proceeds from a very subtle cause, which irritates, and 
chiefly affects the nerves; those of the stomach and bowels 
first, whence those painful, strong, convulsive spasms in 
them; and sometimes the brain and whole system of the 
nerves, whence the convulsions; and lastly those of the 
hands and feet, whence the loss of their motion: and the 
disease and its symptoms being increased and aggravated 
by such things as irritate and stimulate those parts, 
which confirm this opinion, and at the same time indicate 
to us the proper intentions of cure of it; and they are 
these, 

1st. To abate the pain, and take off the irritation of the 
nerves, from whence the convulsive spasms arise. 



138 DISEASES, ACUTE AND CHRONICA!* 

2dly. To procure a free passage through the bowels,- 
and so carry oft' the morbid matter that way, without in- 
creasing the irritation. 

As this disease proceeds from something which greatly 
stimulates and irritates the nervous coats of the stomach 
and intestines, and thereby produces those painful convul- 
sive contractions and spasms, which always attend it; it is 
evident that whatever will abate and take off that irrita- 
tion, must take off the convulsive contractions also, and 
abate the pain; and whatever will increase the irritation, 
must increase them and the pain also: and as all emetics 
and strong drastic purgatives, are well known to operate 
by their stimulating and irritating quality, so they are 
found always to increase the convulsive spasms and pain, 
which attend this disease. And on the contrary, as it is as 
well known that opium takes off all irritation and pain the 
most effectually, especially where the nerves are princi- 
pally affected; as in this, and the opisthotonos and tetany, 
and some few other diseases; wherefore opium is in this 
case a principal remedy, and often repeated experience has 
fully confirmed this: and we have found the following me- 
thod of treating this disease, to be the most safe, expedi- 
tious, and successful; and therefore recommend it to 
others, at least till they can find a better. 

When I have been called in, and found the patient was 
seized with this disease, and that the pain at the pit of the 
stomach, and in the bowels, was very great, as it generally 
is; in order to abate that pain and take off the irritation and 
spasms, I always first give an anodyne; and have generally 
found some of the following forms to answer the best, with 
variations pro re nata. 

5o Extracti thebaic, gr. ij. vel iij. fi. pilul. vel. ]$> philon. 
londin. $L extract, thebaic, gr. i. vel ij . bals. peruv. gut.. 
x. m. fi. bolus; vel. J£> aq. menthse simp. 5'iss. extract, the- 
baic, gr. ij. vel iij. bals. peruv. gut. xx. syr. e mecon. ^ss, 
in. fi. haust. statim sumend. 

By taking one of these, the patient generally finds his 
pain much abated, the irritation is taken off, and the convul- 
sive contractions of the intestines also ; so that their peris- 
taltic motion is restored, and the progressive motion of 



PECULIAR TO THE W« IXDIA ISLANDS, &c. 139 

their contained faeces is more easily assisted by a soft le- 
nient eccoprotic, (for most other purgatives increase it,) 
which must be given as soon as he finds himself tolerably 
easy: but if the pain does not cease, or if it returns again, 
one of the above opiates, or a somewhat smaller dose of it, 
must be repeated till the patient finds himself tolerably 
easy: these may be thought too large doses of the opium, 
but I must observe, that small doses will not answer in this 
case, and the tetany, &c. and they may be given very safely. 

But if the vomiting be so violent (as it sometimes hap- 
pens) that the patient cannot retain any of these on his sto- 
mach, not even the extr. theb. which is in so small a com- 
pass, I have found the following most commonly to stay, 
and take the vomiting off also. 

5> Tart, vitriolat. gr. x. ol. cinnam. gut. i. vel m?nthae 
gut. i. m. exhibe in cochl. i. aq. menthss simp, et repetatur 
omni hora donee cessant vomitiones, deinde exhibe extr. 
thebaic, gr. ij. vel iij. quam primum. :a. 

This most commonly stays the vomiting, even when 
the saline antiemetic draughts will not, and the opiate 
abates the pain and convulsive spasms. 

But if the patient be plethoric, and any symptoms of in- 
flammation attend, which very rarely happens, ten or twelve 
ounces of blood may be taken away, and his stomach may 
be fomented with a proper emollient fotus, and then these 
powders may be given, and the opiate. (68) 

And as soon as the patient finds himself tolerably easy, I 
usually begin to give something of the following kind, 
every two or three hours, till three or four stools are ob- 
tained. 

B> Cremor. tartari pulv. 511J. tart, solubil. siss. tart, vi- 
triolat. ^ij. ol. cinnam. vel menthse gut. iij. mis. fi. pulv. 
in dos. vi. divid. de quibus capiat eeger unam secunda vel 
tertia quaq; hora in vehicul. quovis idon. I usually give 



(68) There are few cases in which bleeding is not useful in 
this disease. It prevents inflammation; relaxes spasms in the 
bowels, and places the blood-vessels in a state to abstract a por- 
tion of the morbid excitement of the intestines, and thus to less- 
'--n the force and danger of the disease. 



140 DISEASES, ACUTE AND CHRONICAL, 

them in a small draught of wine-whey, mint-tea, posset- 
drink, or in an infusion of bread toasted brown, and infu- 
sed in boiling water. 

After taking these powders thirty or forty hours, the 
pain which was at the pit of the stomach, removes down 
towards the lower part of the belly, where a sense of weight 
is usually observed by the patient, and presages stools to 
follow soon, and generally carries both the disease and its 
cause quite off, sometimes in tw r enty-four hours time, but 
seldom fails to do it in three days time: but if stools are not 
thus procured, or that sense of weight perceived in the 
lower part of the belly, by the beginning of the third day, 
I usually add rad. jalappii gr. v. vel. vi. to each paper of 
the powder, and give bals. peruv. gut. xv. mixed with a 
little sugar, and give it in the whey with the powders, 
which I think never fails to give stools on or before the 
fourth day; for I can truly say, that ever since I treat- 
€d this disease i;« this manner, which is now above ten 
years, I have never met with any case, where the patients 
would take their medicines regularly, but stools were 
procured on the third, or the beginning of the fourth 
day at the longest, and often sooner; and the disease with 
all its symptoms were carried off thus with them. But 
I must observe, that the opiate must be repeated when- 
ever the pain returns, and as often as it returns, whilst 
they take these powders. 

And if from some particular circumstances of the pa- 
tient's constitution, or his not taking the medicines, or 
his stomach not retaining them when taken, the pain 
still remains, or returns, and no stools are obtained; the 
opiate must be repeated till the pain and spasms are ta- 
ken off, or greatly abated, that the other medicines may 
take effect; to which purpose, fomenting the region of 
the stomach and all the abdomen, with an emollient an- 
odyne fomentation, every six hours, will be of great 
service: some have recommended a semicupium, but 
often without success, as I have more than once observed; 
and I have always found that fomenting 1 as above, has 
been of much more service; as, 



PECULIAR TO THE W. INDIA ISLANDS, &c. 141 

§> fol althse (vel alceae) miij. menthae flor. sambuci 
chamemeli ana mij. sem. lini. %\. sapon. venet. §i. miscc; 
coq. in aq. Ibviij. deinde adde theriac. androm. §i. piselii 
barbadens. §ij. spir. sacchari tbss,. misce, fi. fotus, quo 
foveant regionem ventriculi et abdom. pannis laneis in 
fotu tepide intinct. sexta quaq; hora, donee cessant do- 
lores. 

And a clyster of the following kind, may be given im* 
mediately after the use of the fomentation; and I some- 
times order an anodyne emollient liniment to be applied 
to the abdomen, after the use of the fotus: as, 

J& decoct, pr. fotu fineaddit. gviij. sapon. venet. 51. pi- 
selii Barbad. §ss. bals. Peruv. 5L ol. ricini Americani vel 
ol. palmse christi 3'iss. m. fi. enema. 5> ung. dialthee ol. 
palm<e christ, ana |i. opii camphor, bals. Peruv. ana 5*1. 
ol. macis per expres. 5SS. misce, fi. liniment ut supra 
utend. 

And if the patient's stomach cannot take or retain the 
powders when taken, the same powders may be dissolved 
in a little boiling water over the fire, and a little aq. 
menthae, bals. Peruv. mixed with sugar, and made a- 
greeable to the patient's palate, and given in the same 
quantity every two or three hours, till they pass and 
give two or three stools; which they usually do, much 
sooner than any other stronger cathartics, as these last 
usually stimulate and increase the disorder. 

If from the violence of the pain, and great irritation 
of the nerves, strong convulsions come on, as it some- 
times happens, I usually give musk with the opium, 
which seldom fails to take the convulsions off; and then 
the above-mentioned powders, or a solution of them, 
must be continued till some stools are obtained. 

As §> moschi orient, gr. x. extr. thebaic, gr. ii. vel 
iii. vel. iv. bals. Peruv. q. s. m. fi. pil. iv. vel. fi. bol. cum 
bals. Peruv. q. s. This seldom fails to take off the con- 
vulsions and the pain, if they can be removed. But no 
stimulating volatile salts, or spirits, nor any medicines usu- 
ally called nervous, that will irritate; neither vesicatories, 
nor^ cathartics, that will stimulate; for all these must be 
avoided and forbidden, as they increase the convulsions; 



142 DISEASES, ACUTE AND CHRONICAL* 

and the last will increase the convulsive contractions of 
the bowels, and at last produce a palsy of the legs or 
hands, or both: but the above powders, or their solution, 
must be continued till they pass downwards, which thev 
scarce ever fail to do, in three days time at the longest, 
and relieve the patient from his misery; and if they do 
not pass so soon as expected, it is better to repeat the 
dose of musk and opium, and wait a few hours longer 
witti patience, in the use of the above powders, which 
will in a little time bring certain relief. 

It is possible that there may be some other particular 
symptoms and circumstances, which may attend some pe- 
culiar patients and constitutions, which I have not men- 
tioned here; but the judicious physician will readily know 
from what is already said, how to make all such alterations 
in the medicines as may be necessary, and how to re* 
move those symptoms* 

And though the patient generally finds himself quite 
easy and well, after these medicines have procured him 
a few stools; yet it is most commonly necessary to keep 
the body a little open for a few days after, by giving 
something of the following nature, once or twice a day, 
in a little whey or gruel for a few days. As, JJ, crem. 
tart, gi* tartar, solubil. sss. tart, vitriolat. Qss. ol. cin- 
nam. gut. i. misce, fi. pulv. primo mane fumend. in haus- 
tu seri lactis.(69) 

But the custom of giving calomel, or any other mer- 
curial preparation, or any drastic cathartic, either at this 
or any other time of this disease, as recommended by a 
late ingenious and learned author,* and is too often giv- 

(69) The treatment of this disease, as advised by our author, 
was generally pursued by the physicians of Philadelphia, in the 
years before-mentioned. Lenient purges were always preferred 
to such as were of a drastic nature. Dr. Thomas Cadwailider 
published a small tract in favour of the former, particularly of 
cream of tartar, which he directed to be given in small but fre- 
quent doses, for several days. As soon as the pain was felt in 
the lower bowels, he aided this gentle cathartic by opening clys- 
ters. By this means the disease was cured without being follow- 
ed by a palsy ot the extremities. 

* Dr/Town on the diseases of the West-Indies. 



PECULIAR TO THE W. INDIA ISLANDS, &c. 143 

en here, I can by no means approve of, at this, or in any 
other time of this disease; because it is well known 
that mercurials have too great a disposition or tendency 
to bring on a palsey, as also to increase it; and that all 
stimulating drastic cathartics are as bad or worse, is as 
well known; both from observation and experience, as 
•also from what has been said before; but there are like- 
wise other sufficient reasons for our not giving them at 
this time of the disease: because the patient is now gen- 
erally reduced pretty low, and his bowels at this time are 
too tender and sore, by the preceding convulsive spasms 
and long continued pain, to bear the irritation of such 
strong purgatives. (70) 

As to the diet of the sick in this disease, it is almost 
unnecessary to say that all their aliments must be thin, 
light, and of easy digestion, as in all other acute cases, 
because they can generally take nothing but what is so; 
but I must observe that some are preferable and much 
more suitable than some others that are equally light; 
and I have always found from repeated observation, that 
wine posset-drink, and? wine whey, and the polenta made 
of bread toasted brown and infused in boiling vvater,(71) 
till it is the colour of old wine or malt-liquor, agree 
much the best with, and sits the lightest and easiest on 
their weak stomachs, and that often when no other food 
or drinkables will stay with them; and they are sufficient- 
ly nourishing in so painful a disease, especially for four 
or five days, as it is now most commonly got over in that 
time, when it is treated in the manner above described: 



(70) Calomel, when given as a purge, was probably hurtful, 
but the editor well recollects to have seen a case of this dis- 
ease suddenly relieved by his preceptor in medicine, by 
means ol small doses of calomel, combined with opium, as 
boon as the mouth was affected. He has several times since 
imitated the same practice with advantage. 

(71) The editor can subscribe to our author's account of the 
efficacy of his polenta in a weak and irritable state of the stom- 
ach in other diseases, as well as in the one now under consider 
rati on. 



144 DISEASES, ACUTE AND CHRONICAL, 

though they used formerly to continue as many weeks, 
and sometimes as many months in this state of misery, 
and then too often came off with the loss of the use of 
theft limbs, or died. 

Light food, of easy digestion, should be continued for 
a week or two, and sometimes longer, after the pain is 
quite over, and they begin to recover; because the sto- 
mach and bowels, are generally now very sore and tender, 
from tire violence of the pain which they have so 
long endured in them; and they often continue to be 
very sore several days after the pain is quite over, till 
they recover their proper tone and strength again. To 
assist which I have always found that easy moderate 
riding on horseback, and taking something of the follow- 
ing kind, has both contributed much to their present re- 
covery, and also to strengthen their bowels, and prevent 
any relaps. As, §> cort. Peruv. grosso modo pulv. £i. 
cort. aurant. gin. rad. cassumunar. rhabarb. opt. ana 
3*iss. bate. Peruv. 5IL vini maderiens. jfcii. m. digere 
loco calid. s. a. et cola, colatur. capiat aeger cochl. tria 
bis vel ter de die vacuo ventriculo. 

The palsey, which formerly very frequently seized 
their hands and feet, and sometimes now also, and de- 
prives them of their proper use and motion, at the going 
off of this disease, as before-mentioned, generally pro- 
ceeds either from giving some strong drastic purging 
medicines, or from some other wrong treatment of the 
disease; and when it is once fixed in their limbs, is ex- 
ceeding difficult to be removed and cured; especially 
when the patient has continued a long time in that lame 
helpless state. Drinking the waters of some of the warm 
chalybeat and sulphurous baths, and pumping the para- 
lytic limbs, or bathing them (not the whole body) in the 
same hot waters, as those of Bath in England, Aix la 
Chapelle in Germany, Barages in the Pyrenian moun- 
tains, or those in Portugal, and most probably those in 
Jamaica, Nevis, and Carolina, if they were properly ex- 
amined, and suitable conveniences were made there, may 
answer as well. These with a little bals. Peruv. camphor 
and extract, valerian sylvest. given in proper quantities 



PECULIAR TO THE W. INDIA ISLANDS, &c. 145 

with those waters, twice a day for some time, with daily 
repeated frictions on the spine of the back and the para- 
lytic limbs, are the most likely, and have sometimes suc- 
ceeded and restored to them the use of their limbs. 

But it is much more easy to prevent this palsey from 
coming on, or seizing the patient, by treating the dis- 
ease in a proper manner as before recommended; than 
it is to cure it, when it has seized and taken away the 
use of the patient's limbs. 



146 DISEASES, ACUTE AND CHRONICA!^ 



OF THE DYSENTERY. 



THE diseases of the intestines are rather more fre- 
quent in this warm climate, than they usually are in Eu- 
rope, especially the dysentery, and the colica pictonum, 
or dry belly-ache, both which we too frequently meet with; 
of the last I have already treated before. We also usu- 
ally have a colera morbus, especially towards the latter 
end of the hot months, as we usually have in Eng- 
land, and the other parts of Europe; but it is seldom 
so severe and violent here, as it often is there, though 
this island is so much warmer; and we too often meet 
with inflammations of the bowels, and sometimes with 
the bilious colic, the flatulent colic, and the hysteric 
colic, though the last is not near so frequent here as it 
is in England: we have also at times, all the different 
kinds of diarrhoeas, as a diarrhoea febrilis, a diarrhoea 
colliquative, and the fluxus hepaticus, all which are 
very different diseases from each other, though they 
all affect the same parts, and should be treated with 
as different methods and medicines, according to their 
different natures and causes; but all much in the same 
manner as they usually are treated in England, when 
they are treated in a rational and proper manner, with 
some allowances for the warmth of the climate. But 
as these last are all judiciously treated on by several 
learned and able physicians in Europe, it is not neces- 



PECULIAR TO THE W. DTDIA ISLANDS, &c. 14? 

sary to say any thing on them here, since they should 
be treated here, much in the same manner as they are 
there; save that a more liberal use of the antiseptics, es- 
pecially in the colliquative diarrhoea and the hepatic flux, 
is necessary, because all the animal humors usually pu- 
tresce more readily, and to a higher degree in this warm 
climate, than they usually do in the colder countries. 

But dysenteries are so frequent in this warm climate, 
that they may be truly said to be endemial, and more 
or less epidemical every year; especially during the rainy 
seasons. For after two or three of the hotter months are 
passed over, and are succeeded by the usual rainy months 
of August and September, in which considerable great 
quantities of rain usually fall, sometimes for several days 
successively together, which are often followed by two 
or three or more clear and very hot days, and then rain 
again, and often so by turns: the falling of the rains, espe- 
cially when in great quantities, renders the air cooler, moist, 
and damp, for many hours, and sometimes days, when it is 
very cloudy, which being succeeded by clear and very hot 
dry days, as is often the case, insomuch that the months of 
August, September, and October are generally called the 
hottest months in the year; these great and often sudden 
changes of the air, almost constantly produce dysen- 
teries, which usually become frequent and epidemical, 
especially among the negroes, who are usually little 
clothed, and more exposed to the inclemencies of the 
weather, and among the white people also; and when the 
above changes of the air are sudden and great, they too 
often become malignant or mali moris also. 

For I have always found from the best observations 
that I could make on the variations of the air and weather, 
in this island, that if the months of May, June, July, and 
August were very hot and dry, and the following months of 
September, Otcober, and November were accompanied 
with much rain, so that the air was rendered cool, moist, 
and damp, and if the intermediate days between the rainy 
days, were very hot, I always observed that dysenteries 
were very frequent and epidemical, and generally were 
more or less malignant, as the above-mentioned changes 



148 DISEASES, ACUTE AND CHRONICAL, 

of the weather were greater or less, more sudden or 
more gradual, and shorter, or of longer continuation. 

Hence must we not conclude, that this great driness 
and heat of the air, especially when it continues long, so 
acts on our bodies, as gradually to change their animal 
oil and salts, from their neutral, soft, bland, smooth, semi- 
ammoniacal state, to a semirancid and semivolatile acrid 
state, whereby they become unfit to perform the func- 
tions of animal life; and by their acrimony so stimulate 
snd irritate the most sensible parts of the body, as greatly to 
disturb and oppress nature? and as she always endeavours 
to discharge and carry off whatever is so oppressive and 
offensive to her, by some of the excretory glands and 
pores, and in this case it is most probable that she first 
endeavours it by exciting a free perspiration and sweat- 
ing, as these evacuations are the most assisted by the 
great heat. But the sudden falling of the rain changing the 
air so as to render it cool, moist, and damp, which as 
suddenly checks and stops that free perspiration and 
sweating, and the discharge of those acrid humors, by 
those ways being thus hindered, they are turned upon 
the bowels, which they constantly stimulate and irritate; 
and so produce a continual secretion and discharge of 
the mucous matter of the intestinal glands, and proba- 
bly some of the acrid humors with it. This still continu- 
ing, increases the afflux of the humors to those glands, 
where they produce an inflammation of those glands, 
and the heat and fever are again increased by that in- 
flammation, and the humors still rendered more acrid 
by that heat and fever; and the momentum of the blood 
being thus increased, its red globules are forced and dis- 
charged, with the mucous matter of those glands, into the 
intestines, and so carried off by stool. And the acrimony 
of the humors being still increased by the heat of the 
fever, and the fever again increased by the acrimony, and 
the thinnest parts of the circulating fluids being con- 
tinually carried off, the remaining fluids are in time ren- 
dered too thick to pass through the smaller vessels, which 
still increases the inflammation, and produces a tenes- 
mus, and violent pain, with all the other bad symptoms 



PECULIAR TO THE W. INDIA ISLANDS, &c. 149 

attending this disease; which if not speedily relieved, 
soon form obstructions, and a total suffocation of the 
sanguiferous vessels, which soon produces a mortification 
of the intestines, that soon ends in death. 

As we have dysenteries constantly returning every 
year in the West- India islands, with those rains at that 
time of the year, which are always epidemical, though 
not always equally malignant, no more than the seasons 
are always equally alike; may we not justly conclude, that 
the dysentery is most commonly thus produced from these 
causes, especially as these causes are sufficient to pro- 
duce it? 

Though it is also probable that it may be sometimes 
produced by infectious miasmata also; which were ex- 
haled from diseased bodies and are floating in the air, and 
received into the mouth with it when we breathe, and there 
stick to the saliva, and are carried with it down into the 
stomach and intestines, where they produce all the above 
mentioned symptoms and effects, when they meet with 
a constitution fitted by the above mentioned causes to 
receive those infectious effluvia, and produce the dis- 
ease.(72) However, I think, that we are certain from 
observation, that this disease, when it is thus produced 
in the manner as above, from the aforesaid causes, it of- 
ten happens that after it has continued a considerable 
time, and many are seized with it at or near the same 
time, that the humors are in time rendered so acrid, se- 
mivolatile, and putrid, that they become infectious, and 
being exhaled from their bodies, but more especially from 
the putrid offensive stools of the sick, into the air, are car- 
ried with it, and often infect those who were well and 
sound before; and thus it becomes both epidemical and 



(72) It is possible the effluvia from the stools of patients hi 
the dysentery, may excite the disease in their attendants. In 
this case, a predisposition exists to the dysentery in the bow- 
els. These effluvia may be rendered inoffensive by obliging pa- 
tients to discharge their stools in a pan or chamber-pot, halt fill- 
ed with cold water, agreeably to the practice recommended by 
Dr. Clark. It even suffocates their fetid smell. 



150 DISEASES, ACUTE AND CHRONICA!-, 

contagious, though it was not the latter at its first inva- 
sion or seizing the first patient. This I have often ob- 
served, especially when great numbers have laboured 
under it at the same time, as often happens among the 
negroes; wherefore I have constantly ordered that the 
close stools should always be emptied immediately after 
they are used, and not suffered to remain in the same 
room with the sick: so that no more infectious putrid 
effluvia might be either conveyed to the sick, or to the at- 
tendants; and I think it is a very necessary precaution, 

I have always observed, that all those diseases, which 
are epidemical, generally seize the negroes the first: is it 
not because they are little or thin clothed, and often 
poorly fed, and much more exposed to all the variations 
of the air, and inclemencies of the weather?(73) 

This disease does not always seize the patients in the 
same manner: sometimes it seizes them with a diarrhoea, 
which is moderate the first day or two, but it gradually 
increases in all its symptoms, till it becomes a perfect 
dysentery, with all its symptoms. At other times it seizes 
them with an oppression and sickness at their stomachs, 
a gentle rigor, with pain in the head, and sometimes all 
over the body, which are soon followed by a fever, with 
griping pain in the bowels, and frequent griping stools. 
The sickness at the stomach increases, and is often at- 
tended with a reaching to vomit, or with vomiting: the 
fever increases; the pulse becomes very quick, and gene- 
rally tense and hard, and sometimes full, though rarely 
so full as it is in most other fevers, neither is the exter- 
nal heat of the body usually so great as it is in many- 
other fevers, though the internal heat be greater. The 
stools become more frequent, the griping pain increases, 
and the excrement discharged is mixed with much 
mucus of the guts, and considerable quantities of blood; 



(73) Negroes, in the West Indies, in common with poor peo- 
ple, in all countries, are most subject to this disease, irom be- 
ing exposed to more o its remote and predisposing causes, 
from vapid aliment, thin clothing, and exposure to the open 
night air, than persons in easy circumstance?. 



PECULIAR TO THE W. INDIA ISLANDS, &c. 151 

and sometimes nothing but blood and mucus is dis- 
charged by stool; at other times a bloody sanies, or ichor, 
like bloody beef-brine, and a tenesmus comes on, with a 
continual painful neediness or desire of going to stool. 
All these symptoms continue and increase, if not timely 
relieved by proper remedies: the fever increases, the pulse 
is very quick, the thirst aud internal heat great, though 
the external heat continues to be less than in most other 
fevers, as all the humors have so great an afflux to- 
wards the bowels, which too often deceives the injudi- 
cious oruncautious practitioner. Now the patients strength 
sinks, he grows delirious, his extreme parts cold, accom- 
panied with cold clammy sweats; his pulse becomes ir- 
regular, unequal, and often intermits; the stools some- 
times run from the patient insensibly; the coldness of the 
extremities and the cold sweats increase, and all the oth- 
er symptoms are worse, the patient grows very faint, 
and a mortification seizes the bowels, which soon ends in 
death.(74) 

From the nature of the preceding causes, their man- 
ner of acting, and the symptoms which attend this dis- 
ease, we must take our intentions of cure, which are 
these; 

First, To carry off those acrid, putrid, and infectious 
humors, as soon and as safely as we can; and to abate 
and take off the fever. 

Secondly, To stay the purging, heal the inflamed and 
abraded intestines; and then corroborate and restore 
their tone and proper action. 

As we always observe, that this disease is constantly 
attended with a fever, in a greater or less degree; it is 
always necessary to take away some blood, more or less 
as the nature of the fever, the strength, quickness and 
fulness of the pulse do indicate, and the strength and other 
circumstances of the patient will permit; in order to abate 



(74) A more correct history of the dysentery has seldom been 
given, than the above, by our author. It should be read over 
and over by everv student of medicine. 



152 DISEASES, ACUTE AND CHRONICAL, 

the fever and inflammation as well as the increase of heat, 
putrefaction and acrimony of the humors. 

And as there is such an afflux of the humors to the 
stomach and bowels, attended with a sickness, reaching, 
and sometimes vomiting, an emetic is clearly indicated; 
and the sooner it is given, the better, both to carry off 
those humors, and as much of the infectious matter as 
we can, as also to revulse them from the bowels, and 
clear the stomach, that the medicines to be given after 
may have the better effect; and it is well known that the 
ipecacuanha in powder is the best in this case, as it ope- 
rates the safest, and somewhat restringes the bowels after: 
and in order to answer the first intention of cure, and 
carry off as much of those putrid humors as we can, in 
the beginning of the disease, it is necessary to give a 
dose of torrified rhubarb mixed with an opiate, to procure 
the distressed patient some respite and ease, and abate the 
flux; and I have found something of this nature the best. 

§> rad. rhei tor. pulv. B"i. electar. e scord. 5. ss. ex- 
tract, thebaic, gr. iss. vel ii. ol. cinnam. gut. i. syr. e 
mecon. q, s. m. fi. bol. hora post emet. operat. su- 
mendus. 

If the fever and purging are considerably abated by 
these medicines, as they sometimes are, when given ear- 
ly at the beginning of the disease; giving something of 
the following nature, sometimes takes the remaining fe- 
ver off, stays the flux, and heals the bowels, and some- 
times effects the cure, or at least greatly abates them, if 
a proper regimen is prescribed, and strictly followed by 
the patient. 

§> cort. restring. Barbad. (bastard locus diet.) visci 
arboris limonifer. (misleto of the lemon tree diet.) ana 
|i. cort granator. §ss. cinnamomi 5iss. misce coq. in 
aq font. ibii. ad Ibiss. et sub. finem coction. adde elec* 
tar. e scord $i, coq. parum et cola, ibiss. colaturseaddetinct. 
terras japon §i. sp. nitri dul. §ss. sal. nitri. purif. fss. 
syr. e mecon. |i. m. fi. decoc. cujus capiat aeger cochl. 
tria vel quatuor tertia quaq; hora, vel post singulam al- 
vi dejectionem liquidam. 



PECULIAR TO THE W. INDIA ISLANDS, &c. 153 

The quantity of the sal nitre, and also of the opiate 
here, may be increased or diminished as the physician 
sees it necessary. I have here ordered the cortex re- 
string. Barbad. and the viscus arbor limonifer, because 
they can be easily gotten in Barbadoes, and are the 
most efficacious cooling restringents in this and some 
other cases. The first is the bark of a non descript 
tree; and makes a fine extract, which, as well as the bark, 
both greatly restringe and strengthen without heating, 
and both may be brought to England; and I wish we 
had them here for the benefit of the profession, and the 
good of mankind : and the misleto of the lemon-tree, 
on which and the lime-trees it only grows, and is a fine 
subacid cooling restringent, and was used as a secret in 
the cure of this disease for many years, but I fear will 
not retain its virtues when brought to England, neither 
will it be got to grow here; but both may be tried. 
I have often experienced the good use of both this, and 
the above bark and extract, and wish we had them here. 
As I write on this disease, as well as on most of the 
other diseases in this book, principally for the use and be- 
nefit of the inhabitants and practitioners in Barbadoes, 
and the other West- India islands, who in general have too 
little learning, I have been more explicit and copious 
in the theory and reasoning on those diseases, than 
would have been necessary if I had only written for the 
use of the learned, which I hope the last will excuse, 
and pardon this and the preceding digression. 

Giving sal nitre also in this case, where such a violent 
purging attends, may be thought by those who are not 
able to see the reasons for giving it, not only a new,, but 
an injudicious practice, as it is known that nitre will 
sometimes gently loosen the belly. But I must observe 
to such, that it rarely or never happens that the pur- 
ging, though violent, takes the patient off, but the 
violence of the fever, and the inflammation of the intes- 
tines, which ends in a mortification, especially in this 
hot climate, and kills him. And that it is both injudi- 
cious, and bad practice to stop the purging, by strong 
restringents and hot alexipharmic medicines, before the 

v 



154 DISEASES, ACUTE AND CHRONICAL, 

fever and inflammation are abated or taken off: and if 
they can stop the purging by such medicines, the fever 
will be thereby so increased, as to bring on a train of fa- 
tal symptoms which will soon put an end to his life. 
Wherefore the physician's greatest care should be to 
take oiF the fever and inflammation, by bleeding, &c. 
and a proper use of antiphlogistics, given with gentle 
cooling restringents, and suitable anodynes to abate the 
irritation on the bowels. And in this case I have always 
found nitre thus given, or mixed with a little elect, e 
scord. or bals. locotel. to be the best antiphlogistic. 

And even to children, when the bloody stools have- 
been frequent, and with much pain, that after bleeding t 
an emetic, and a little torrefied rhubarb, giving nitre 
mixed with a little red coral, in an anodyne testaceous 
julep, has in a short time, both taken the fever and in- 
flammation off, and the purging also soon ceased, and 
they soon recovered, being taken at the first beginning of 
the disease. For if we can but take off the fever and in- 
flammation, the purging generally soon stops, as its cause 
is removed: or if by reason of too great a laxness and 
weakness of the bowels, the purging continues, it may 
be soon stayed by a moderate restringent anodyne and a 
clyster. 

But if the fever still continues, or the inflammation 
remains, after bleeding, and the use of the above-men- 
tioned medicines, and the bloody stools with much pain 
are not abated, as too often it happens, bleeding must be 
repeated on the second or third day after the first bleed* 
ing; and in some cases more than once, especially where 
the quickness, hardness, and fulness of the pulse indicates 
it; and that to such a quantity as the urgency of the 
symptoms require, and the strength of the patient will 
bear: after which, it will be necessary to give the ipeca- 
cuanha in small doses, from gr. ij. to gr. v. mixed with 3i. 
of theriac. androm. twice a day, and an anodyne, after 
it has vomited the patient once or twice, for three or four 
days, and the antiphlogistic anodyne restringent decoc- 
tion as before, in the intermediate times of taking the ipe- 
cacuanha, which may also be given after, if the stools 



PECULIAR TO THE W. INDIA ISLANDS, &c. 155 

still continue; these seldom fail to give relief, and take 
off the disease. 

But if the fever and inflammation are considerably 
abated, or taken off, and yet the bloody or brine-like 
stools continue, and are frequent; giving a dose or two, 
and sometimes a third dose of the stibium ceratum, at 
proper distances after each other, and a suitable opiate a 
little time after the last, has been of great service: but 
I must observe that this medicine, how much it may be 
recommended and extolled by some persons, though it 
may be a good medicine when properly timed; yet as it 
is frequently and promiscuously given at all times of 
this disease, and in all circumstances, by some persons, 
it cannot succeed; for if the fever and inflammation are 
not first taken off, or considerably abated, it seldom or 
never answers their expectations: but these being taken oft, 
or greatly abated, it sometimes proves to be a good medi- 
cine, though I think I have seen the ipecacuanha in small 
doses answer much better even then, when it would not. 

But when we find that the fever and inflammation still 
continue, after all the repeated evacuations of bleeding 
and vomiting, Sec. and the patient is reduced so low, that 
he cannot bear any further evacuations, and yet the fe- 
ver continues, with a very quick, low, weak pulse, and 
is delirious, his skin hot and dry, and the stools frequent 
and bloody, or brine-like; I have with great pleasure seen, 
that giving the ipecacuan. in small doses, viz. gr. iij. 
and repeating it every three hours, till the patient had ta- 
ken four doses, and increasing the last dose to six or 
seven grains, it has, after giving a gentle puke or two, al- 
most surprisingly restrained the flux, and brought on 
a fine free diaphoresis all over the body, which was con- 
tinued for some hours, by being properly encouraged by 
drinking amall warm liquids; and the delirium, tremors, 
and all the other bad symptoms went off, and the patient 
has from that time soon recovered, by only giving a few 



15<> DISEASES, ACUTE AND CHRONICAL, 

doses of a restringent diaphoretic opiate, as before; and 
was thus as it were snatched from the jaws of death. (75) 

But we cannot always expect to meet with such hap- 
py success, in every patient and case; yet in these cir- 
cumstances, I have more than twice seen this method 
succeed; so that the fever and all its bad symptoms have 
been either taken off, or so much abated, that by giving 
something of the nature of the above-mentioned restrin- 
gent anodyne decoction, or such like medicines for a few 
days, and a few proper clysters with a suitable regimen, 
the fever has been entirely taken off, and the purging 
also, and they recovered; at least I have always found 
this method the most successful, even after all other 
methods have failed. 

There is another painful circumstance which frequent- 
ly attends this disease, which is a painful griping accom- 
panied with a great soreness in the bowels; and most 
commonly arises from the great heat and acrimony of 
the humors, and their continual motion downwards; 
and the fine soft mucus which lines and defends the in- 
testines being carried off by the so much purging, those 
acrid humors irritate and inflame, and sometimes almost 
corrode the tunica villosa of the guts, so that they are in 
part excoriated; and sometimes large portions of that fine 
membrane has been known to come away several inches 
long, by which the intestines become exceeding sore and 
painful, when this pain and soreness is found to be pret- 
ty high up in the guts; bals. locotelli, or the following 
electary, and the wax emulsion, are found to be the most 
effectual remedies: As, §> electar. e scord. bals. locotel. 
ana §i. sperm, ceti, puiv. e bolo cum opio ana 5iss. 
syr. balsamic, q. s. misce, fi. elect, cujus capiat aeger. 
q. nuc. mosc. quarta, quinta vel sexta quaq; hora, super- 
bib, emuls. cum cer. prseparat cochl. tria. 

(75) The apparently weak state of the patient, is no objec- 
tion to the use of the ipecacuanha in this advanced stage ol the 
disease. Dr. Huxham has justly remarked, that patients are of- 
ten benefited by emetics, when they are too weak to bear any 
other depleting medicine. 



PECULIAR TO THE W. INDIA ISLANDS, &c. 157 

But when the pain and soreness are found to be lower 
down in the belly, it most commonly arises from an ex- 
coriation, or from little small ulcerations of the rectum 
or secum, which the acrid humors irritate, and produce 
a painful tenesmus; in which case, not only the above- 
mentioned healing medicines are necessary, but soft bal- 
samic healing clysters must be frequently injected also; 
which may be made of fat broth, or milk, mixed with 
bals. locotel. wax, sperm, ceti, and an anodyne; as, elect* 
e scordio, theriac. androm. or tinct. thebaic. 

But this tenesmus, especially when the disease has 
been severe, and has continued a considerable long time, 
and is situated low down in the belly, most frequently 
arises from the indurated faeces; which are often formed 
into hard round lumps like balls, by the convulsive 
spasms of the guts, and are almost half baked by the 
heat and fever attending the disease, and often are pretty 
large and very hard, as I have often observed them to 
come awav in the latter end of it, that it is almost sur- 
prising to think how these hard lumps should remain in 
the guts so long, and such a violent liquid purging con- 
tinue all that time, and they not be carried off with it; 
as is almost incredible, if they did not so frequently come 
away at the last: and so long as these lumps continue in 
the intestines, they must very much irritate and stimulate 
them, as they are in that tender sore excoriated state, 
and so long will the tenesmus remain. In this case, a 
proper purgative and suitable clysters, must be given to 
carry those lumps off; but I must observe, that I cannot 
approve of giving sena in any shape, or at any time in 
this disease, notwithstanding that the great and honest 
Dr. Sydenham (to whom all professing the medical art 
are much obliged, for the many useful observations and 
discoveries which he made) frequently used and recom- 
mends it; because it is observed that this drug always in- 
creases either more or less, any inflammation; but this 
probably was not known in his time: and as some de- 
gree of inflammation, more or less on the intestines, al- 
ways attends this disease; giving sena must consequently 
increase it, and render the evil worse: but I have always 



158 DISEASES, ACUTE AND CHRONICAL, 

found that giving a little manna and rhubarb, with a 
little sal. polychrestum and oil, seldom fail to carry these 
hard lumps quite off; and it may be assisted if neces- 
sary with a clyster of warm water, a little honey and oil, 
and a small quantityof soap to dissolve those lumps, and 
render the gut more slippery, and their exit more easy; 
which method seldom fails. And when these lumps are 
thus carried off, the patient usually soon recovers with 
the use of the above-mentioned balsamic healing med- 
icines, and a clyster or two of the same kind; with a suit- 
able soft, healing, and nourishing diet, at the same time. 
I am very sensible that there are, and often may be, 
some other circumstances, and considerable variations 
in the symptoms which at times do attend this disease, 
either arising from the different epidemical constitution 
<rf different years, or from the different constitutions of 
the patients, which may require some variations in the 
method of treating them, as well as in the medicines to 
be given: but it is neither possible nor necessary, to de- 
scribe or mention them all here; since every judicious 
physician will be able to observe them, and to make such 
alterations both in the methods of cure, and such varia- 
tions in the medicines, as may be necessary: and these 
are sufficient, and I hope may be of service to some in the 
practice; wherefore I communicate them to the public, 
and sincerely wish that they may be as useful to others, 
as some of the observations have been to me. 



PECULIAR TO THE W. INDIA ISLANDS, &«♦ 159 



OF THE OPISTHOTONOS AND TETANY, 



THIS is a most painful and dangerous disease, 
which was well known, and is often mentioned by the great 
Hippocrates, and the other Greek physicians, though 
they most commonly speak of it as the consequence and 
effect of wounds made by darts, or other weapons, and 
have not so accurately described it as it could be desired; 
and few of the moderns have done any more than cur- 
sorily mentioning it, not even Bontius, who lived some 
time in the East-Indies, has but very imperfectly descri- 
bed it; though it is probable that he saw it often, although 
it is so very seldom seen in England, and the other cold 
northern countries, yet it is so frequently seen in the 
West-India islands, and the neighbouring warm countries 
that it may justly be said to be indigenous, or at least ende- 
mial in those countries which are within or near the torrid 
zone; hence it might be more frequent in Greece than 
it is in England, as the island of Coos, and adjacent 
countries, where the great father of physic lived and 
made his observations, are much warmer. 

The Greeks distinguished this disease by these three 
names, as they express the primary effects it has on the 
body, fcwgoaGorovos, QwtaQoTovo; 9 tstwos, which the Latins called bv 
•ne name, rigor nervorum, and we a tetany or convulsion, 



160 DISEASES, ACUTE AND CHRONICAL, 

When the body was bowed and bended down forward, 
the Greeks called it an emprosthotonos; and when it was 
bended backwards in a curve, and immovable, they 
called it an opisthotonos; and when the body was fixed 
in an erect, rigid, immoveable posture like a statue, or 
when a limb was so fixed, they called it a tetanus. The 
first is very seldom seen, though the two last are very 
frequent in the warm climates. 

This disease, though distinguished by these three 
names, may most properly be called but one disease; as they 
generally ail three arise from the same causes, and only 
differ from each other, as they reduce the body into the 
three different positions before-mentioned. And all these, 
or this one disease, in general arises from three causes, 
which are very different from each other; though in some 
particular cases and constitutions there may be some 
other concurring causes. The- first, is from a slight small 
puncture with a pin, needle, or small bone of a fish, a 
nail, or small splinter of wood, accidentally run into the 
foot, hand, finger or toe, the head, or some other nervous 
parts of the body; or from a small wound with a sharp 
edge of a stone, often not much more than skin deep, 
and too often from the ligatures on the arteries (probably 
with a nerve,) after the amputation of a limb: it is diffi- 
cult to conceive how such a small slight puncture or 
wound, and such a trifling cause as a small puncture 
with a pin, a small bone of a fish, or a nail, or a small 
slight cut with a sharp stone, but little more than skin 
deep, in such remote parts of the body, should produce 
such violent symptoms, and so fatal a disease; nay it is 
almost incredible to those who never have seen such 
cases, yet it is but too certainly true, as both I and many 
others have but too often seen them. 

Secondly, It often arises from taking cold, by suddenly 
exposing the body to a current of cool air, when warm 
and sweating, or being suddenly wet when warm; or 
going into cold water when sweating. And lastly, young 
children are frequently seized with this disease, from a 
retention of the meconium, or from a cheesy matter, or 
something which is acrid, taken into the stomach and 
bowels. 



PECULIAR TO THE W. INDIA ISLANDS, &c. 1G1 

These causes are all too frequently followed by an 
opisthotonos and tetany, and when from the first mention- 
ed causes, it most commonly comes on between the tenth 
and fourteenth day after such slight puncture or wound 
is made, (and sometimes though very rarely sooner) 
than the tenth day, and often when the small wound 
has given the patient little pain or uneasiness, and has no 
bad appearance, but has digested and looked well, and 
often when the puncture or wound has been perfectly 
healed up by some common plaster, and has been well 
for several days before the convulsions have come on, 
and that without any fever, or other symptoms but as 
hereafter mentioned. (76) 

But when this disease proceeds from the second men- 
tioned causes, viz. from suddenly taking cold, it usually 
comes on much sooner, though they have only had the 
common symptoms of catching cold, with little or no 
fever till the fourth or fifth dav after the convulsive 
symptoms have seized the patient, when a fever of the 
inflammatory kind usually comes on. 

In children, from the above-mentioned causes, it usu- 
ally still comes on sooner. 

The patient usually first complains of an uneasy sen- 
sation, and small tenseness about the praecordia, and a 
stiffness in his jaws, which gradually increases, and brings 
on a difficulty in swallowing, but no swelling either in- 
ternally or externally appears in the throat; and a pain 
all along, the spine of the back, with a contraction and 



(76) Danger of tetanus, from a wound in a tendinous part of 
the body, should always be apprehended when it is not follow- 
ed by inflammation. It is because wounds in the soles of the 
feet and in the palms of the hands so seldom inflame,, that te- 
tanus is so frequently the consequence of them, especially in 
warm climates and warm weather. The disease is generally pre- 
vented by dilating the wound, and irritating-it with spirit of tur- 
pentine, or Spanish flies, or any caustic application. It would 
seem, from this fact, that reaction is a law of animal matter, and 
that disease or disorder, in some part of the body, is the neces- 
pry consequence of irritating impressions made upon it, 

X 



162 DISEASES, ACUTE AND CHRONICAL, 

btiffness of the dorsal muscles, and those of the neck 
soon follow, and gradually increase for a day or two; 
and the head, neck, and back-bone, are gradually and 
strongly bended backwards, and the body is fixed 
and retained in that retrocurved posture, and the jaws 
are now close locked and immoveably fixed, and most 
commonly an impossibility of swallowing any thing, from 
the muscles serving for deglutition being fixed in a 
rigid state, now comes on; if any thing that is liquid 
can be got into the mouth, which is usually about the 
third or fourth day, and sometimes sooner; now frequent 
strong convulsive spasms come on, first under the 
sternum and on the diaphragm, and quickly extend 
themselves to the jaws, neck, and the whole spine of the 
back, with such violence and force, as well as dreadful 
pain, as often raise the body with a sudden jerk quite 
up from the bed, or place on which it lays; to a consid- 
erable height; at other times only so that his occiput and 
heels only touch them, the body forming part of an arch, 
if the patient lays on his back, which is the easier posture 
of the two, or almost a circle, by his head and heels 
being brought so near together if he lays on his belly, 
which they rarely can bear to do, though sometimes the 
head, neck, and back, are only retrocurved, and the legs 
strongly and rigidly extended. As the disease advances, 
these strong convulsive spasms become more frequent, 
and also more violent, and now return every ten, fifteen,, 
or twenty minutes; which reduces the poor patient to the 
most distressed condition, both from the violence of th£ 
pain wich he continually feels, and the dread of the fre- 
quent returns of those violent convulsive spasms, which 
greatly increases it, and he continually expects; and now 
the disease has become a perfect tetany, and in the in- 
tervals between those spasms, he lays in a rigid immove- 
able state; except that they most commonly can move 
their tongue and speak, as also their fingers, but not 
their arms. When the disease proceeds from a puncture 
or wound, I never yet saw or observed any fever attend 
it; the pulse is generally small, regular, and rather slow- 
er, but usually a little harder, as well as the heat of the 
body, no greater than when in health; and they usually 



PECULIAR TO THE W. INDIA ISLANDS, &c. 163 

breathe freely and well, as when well, except during the 
time of, and a little after the spasms, when the pulse is 
often small, fluttering, and irregular, for a short time, 
and the breathing quick as if violently exercised, but 
the spasm being over, they both soon became calm, slow, 
and regular again; but the body is sometimes covered with 
sweat, from the violence of the agonies, yet no feverish 
heat attends; neither is the thirst great, or the tongue foul, 
though it is often stiff and attended with a torpor, arising 
from the contraction of its muscles; the urine not much 
altered, only a little higher coloured and less in quantity, 
as they can drink little, and sometimes none: the belly is 
generally costive, and drawn inward and flat, and all the 
abdominal muscles are tense, rigid, and contracted, as 
are most of the muscles of the body after the tetany 
comes on. They seldom can sleep, they only get some 
short slumbers, from which they are soon roused by the 
convulsive spasms, especially towards the latter end of 
the disease, when they can seldom get any: the coun- 
tenance is mostly pale and contracted, and strongly ex- 
presses great anxiety and distress. Thus the convulsive 
spasms continue to return more frequently and with 
greater violence, till at last a general strong convulsion 
puts an end to their misery; and in this case they most 
commonly retain all their senses to the last moment. (77) 
They usually continue in this state with these violent 
symptoms, gradually increasing to the fifth or seventh, 
and sometimes to the tenth or eleventh day; but when 
the disease comes on with more violence at the first, and 
its symptoms increase more quickly in their violence, 



(77} Diseases are obstinate or dangerous, in proportion as 
they are insulated, or confined to one of the systems of the bo- 
dy. The tetanus, which is confined chiefly to the muscles, is a 
proof of the truth of this remark. Its greater mortality, when 
it arises from a wound, than from any other cause, is occasion- 
ed by its being attended with no fever. An affection of the blood 
vessels, by diffusing the disease^ lessens its danger and frequent* 
]y cures it. 



164 DISEASES, ACUTE AND CHRONICAL, 

and return more frequently also; they often put a period 
to life on the third or fourth day, if the violence of the 
symptoms are not abated by suitable medicines; at other 
times when less violent it continues longer, and usually for 
some weeks before they perfectly recover the proper 
tone of the nerves and muscles again; but if they survive 
the ninth or eleventh day, they most commonly recover in 
three or four weeks time; though not the perfect tone- of 
the nerves, and the use of the muscles in less than 
five or six weeks time, and sometimes longer. 

When the opisthotonos and tetany arise from taking 
cold, it is attended with all the same symptoms, and they 
usually come sooner on after the taking cold, than when 
from. a puncture or wound, though not usually with more 
violence, and without a fever in the first three or four 
days, though the pulse is usually a little more full, and a 
little harder, though seldom quicker during those first 
days, but most commonly about the fourth or fifth day, 
the pulse begins to be both more full, and more quick and 
hard, and a fever comes on with some inflammatory 
symptoms, which indicate bleeding, and some are a little 
delirious at times, and their blood is now a little more 
florid and more dense, than it usually is in the former, 
where it usually is more lax and of a looser texture, and 
somewhat less florid, and sometimes mixed with darker 
spots: but in all other respects, except that the thirst is 
greater, the symptoms and progress of the disease are 
the same as in the other, as also its fatal effects rather 
more so, if not timely relieved by proper remedies. 

Infants likewise, who are seized with this disease, 
usually have the symptoms and the convulsions, as also 
the tetany coming on sooner, and generally more or less 
of a fever with them; and the insultus epilepticus, as 
Dr. Sydenham calls it, if it continues any time, is in this 
hot climate changed into a tetany in them. 

It is generally observed that the negroes are more sub- 
ject to this disease, than the white people usually are; 
and it must be allowed, that the negroes are seized with 
it much more frequently than the white people are: but 
I apprehend that this only proceeds from the negroes 



PECULIAR TjO THE W, INDIA ISLANDS, &c. 165 

going barefoot, and thereby being more exposed to such 
injuries, and their being worse clothed, and accustomed 
to labour with, or in such work as renders them more li- 
able to get such wounds, and a custom which many of 
them have of going into the cold water when they are 
sweating on the road, &c. which render them more liable 
to this disease; but the white people are much more sub- 
ject to this disease in this hot climate, than they are in 
the colder countries. 

As this disease so frequently proceeds from such slight 
causes, it is extremely difficult to account for it, in a ra- 
tional and satisfactory manner: to say that it is effected 
by the consent of the nerves, one small nerve being lace- 
rated or wounded, gives great pain, and that is commu- 
nicated to, and affects the whole nervous system: this 
may be plausible, and may satisfy some people, but it is 
far from being clear and satisfactory, to an exact inqui- 
rer; for the pain is generally ceased in the wounded 
part, and the small wound often perfectly healed up and 
well, several days before either the convulsions, or their 
preceding symptoms come on: and how such a cause, 
which has nothing acrid in its nature, when the small 
instrument which made the wound is removed, should 
lay still, and often without pain, for ten days or more, 
and then produce such terrible effects; at present only 
serves to shew us how imperfectly we are acquainted with 
the structure and nature of the nerves and their contain- 
ed fluid, and how they act so as to produce their various 
and wonderful effects; and also shews us how much a 
further knowledge of them is wanting, and ought to be 
inquired into, and obtained if possible, 

I think we may say, that all we know at present of 
this matter, is, that we know by observation, that these 
slight causes, do actually produce those terrible effects. 
And that we also observe that the will or thought, which 
is not matter, can act on the body which is matter, and 
give it motion, &c. but how either of these act, so as to 
produce their peculiar effects, we know almost as little 
of the one, as we do of the other: though there may be 
snme more probability of obtaining some farther know- 



156 DISEASES, ACtJTE AND CHRONICAL, 

ledge of the former, than we can hope for of the lattery 
and that if it ever be obtained, it must be by accurate 
observation, and just inductive reasoning. 

But till further discoveries are made of the nature and 
action of the nerves, we must be content with such ob- 
servations as we have, and such reasonings as we can 
justly draw from them, and endeavour to keep as near 
to truth, as we possibly can. 

We know then from observation, that there is such a 
tiling as a consent of parts, or that one part of the body 
being irritated or hurt, another part of it will be affected 
in the same manner, though not hurt; as a moat falling 
into one eye, considerably affects both eyes; and an in- 
flammation, or a stone, in one kidney, greatly affects them 
both, and the stomach also, as it receives a branch from 
the same nerve; and the same is observed of some other 
parts of the body. We have an account in the philosophical 
transactions, by Dr. Short* of a small sharp bone which 
closely adhered to a branch of the crural nerve, which 
being irritated by certain motions of the leg in which it 
was, it so irritated and affected the whole nervous system, 
as to bring on strong epileptic fits, and greatly affect the 
whole body with strong convulsive motions. And there 
seems to be a great analogy between this case, and what 
happens in this disease, both as to the cause, and the 
cure; for that bone being taken out, the patient was freed 
from his epileptic fits: and in this case, the lacerated nerve 
being entirely divided above the wound, I have found 
it abate the convulsive spasms, and contribute much to* 
wards the cure; wherefore I have made dividing the nerve 
near to, and above the wound, one of the first intentions 
of cure in this disease, when it arises from a puncture or 
wound. 

The causes of this dreadful disease, may be most prop- 
erly divided into three, (though in some particular cases, 
there may sometimes be some other concurring causes) 
which are very different from each other. First, a small 

* Philos. Transact. Abridg. vol. 7. 



PECULIAR TO THE W. INDIA ISLANDS, &c. 16? 

puncture or wound in the feet or hands, or sometimes 
in the head, or in other parts of the body; though most 
commonly in the two first, which are most exposed to 
such injuries, especially in the negroes who go barefoot, 
and thence are more subject to this disease. Secondly, 
catching cold suddenly, when very warm and sweating 
with exercise, labour, or otherwise; and especially if any 
part of the body, which is more nervous and sensible, 
was any way contused before. And, thirdly, in young 
children, from a retention and insufficient disharge of 
the meconium, or from an acrid cheesy matter generated 
and retained in their tender stomachs, or from any acrid, 
acid humor which is retained in, and irritates their 
tender bowels: for the insultus epilepticus as usual in 
children in England, if it continues any time in this 
warm climate, is frequently changed in them into a tetany, 
and often proves fatal. 

These being the causes of this disease, the proper in- 
tentions of cure, evidently appear to be, first, To remove 
and take away the irritating cause which affects the nerves ; 
and then to diminish and take off the stimulation and 
irritation of the nerves. And secondly, To relax the rigid 
tenseness and contraction of the nerves, tendons, and 
muscles, of the parts affected. For the old adage, Tollc 
causam et cessabit effectum, is as justly applicable in this, 
as it is in all other cases. 

Wherefore, when we are first called, and find that 
either the opisthotonos, or tetany, or their presaging 
symptoms, have seized the patient, and that they proceed 
from such a puncture, or small wound, as before men- 
tioned, it is necessary to call in a surgeon to examine the 
puncture or wound very carefully, that if any part of the 
splinter, fish bone, needle, or nail remain in the wound, 
he may take it away. Then in order to take off the sense 
of the irritation of the wounded or lacerated nerve, and 
prevent its being conveyed to the other nerves, let the 
surgeon make an incision near to, and a little above the 
puncture or wound, so deep as totally to cut the lacerated 
nerve in two, which conveys the sense of the irritation 
from the puncture or wounded part; then dress both the 



168 DISEASES, ACUTE AND CHRONICAL, 

wounds with a mild digestive mixed with a little opium, 
to lessen the irritation and pain more. (78) 

This being done, I generally give an opiate, as, the 
following bolus, draught, or pills as soon as I can, which 
most commonly takes off the nervous spasms, and greatly 
abates the convulsive contractions and tetany also. §> mos- 
chi oriental, gr. xii. extracti thebaici gr. ii. vel iii. 
theriac. androm. 3L bals. Peruv. q. s. misce, fi. bolus, 
statim sumend. vel. §> aq. alex simp. gjss. spir. lavend. 
comp. 5j, sp. c. c. ver. gut. xxx. moschi orient, gr. viii. 
extracti thebaic, gr. ij. bals. Peruv. gut. xx. syr. e me* 
con. sss. m. fi. haust. quam prim, sumendus. vel. §> ex- 
tract, thebaic, gr. ij. vel, iij. moschi orient, gr. x. bals, 
Peruv. q. s. misce, ii. pil. iv. statim sumend. 

And one of these must be repeated, every twelve, ten, 
eight, or six hours, accordingly as the convulsive spasms 
are more or Less violent and strong, and return the often- 
er; and sometimes I have found it necessary to repeat 
them oftener than every six hours, where the spasms were 
very great, and returned very often, or where the tetany 
was violent; neither need we fear any bad consequences 
to attend the giving such large doses of the opiates, or the 
repeating them so often, where the convulsive spasms are 
so violent, or return so frequently, though to persons who 
are not accustomed to take opium in any shape ; nor have 
I ever seen that the giving such large and frequent doses 
of the opiates in this case, have ever produced any stupor, 
or great disposition to sleep, though I have ordered six- 
teen or twenty grains of extr. thebaic, to be given in the 
space of twenty-four hours, where the spasms were vio- 
lent, yet they seldom procured more than two or three 
hours'sleep, and seldom more than one hour at a time 
without being awakened by the spasms, and rarely more 
than three hours sleep in the twenty-four hours time, and 
that most commonly without any stupor, or heavy sleepy 



(78) From the remarks made in note 77, and which have 
been confirmed by experience, the application of this mild 
and anodyne ointment is calculated rather to induce than to 



prevent tetanus. 



PECULIAR TO THE W. INDIA ISLANDS, &c. 169 

disposition ; yet I have observed that the opiates have al- 
ways greatly abated the convulsive spasms, and the opist- 
hotonos and tetany also; and when they are given with 
musk, I think that I have sufficient reasons from obser- 
vation, to say that they both more effectually remove, 
and sooner take off this much dreaded disease. And as 
the convulsive spasms abate and return less frequently, 
the intervals between giving the doses of musk and opium 
may be made longer, and longer, till the spasms entirely 
cease, and the patient can begin to move and help him- 
self, and at last the spasms entirely cease, when these 
medicines may be entirely left off, though it will not be 
proper to leave them off entirely till then. 

But in order to remove these painful symptoms the 
sooner, and relax the rigid tense contraction of the 
nerves, tendons, and muscles of the parts affected, it is 
necessary to foment the prsecordia, jaws, neck, and spine, 
with an emollient relaxing fomentation, four or five 
times a day; and I have found that something of the fol- 
lowing nature has succeeded the best; §, fol. altheee vel 
alceae. m. iv. salvee, flor. sambuci, ana m. ij. sem. lini 
contus. |ij. sapon. venet. gij. sal ammon. crud. §j. m. 
coq. in aq. cong. j. deinde adde pisselii Barbadoens. 
§iij» in spir. sacchar. com. Ibss. solut. theriac. androm. 
gij. misce, fi. fetus, cum quo foveant region, prsecord. 
faucium et spinae dorsi, tepide ope pannis laneis s. a. 
sexta quaq; hora. After which let the same parts af- 
fected be anointed with the following ointment, each time, 
and then be covered with flannel. 

I$> liniment, saponac. volatil. nervin. pisselii indie, ana 
§j. bais. Peruv. 3 ij . ol. lavendul. rorismar. ana gut. xx. 
opii 5j. misce, fi. liniment, ut supra utend. 

Some have strongly recommended the use of the 
semicupium in this case; and I have known it used seve- 
ral times, and its use seems to be both very reasonable 
and promising; but I have always observed 'that the pa- 
tients have received more benefit from the use of emollient 
fomentations and anointing the parts affected, as above, 
than I ever could observe from the warm bath; and I have 
more than once known the patient die immediately after 
being taken out of the warm bath, though the bath was 

Y 



170 DISEASES, ACUTE AND CHRONICAL, 

not made too warm, being only about ninety-five degrees 
in Fahrenheit's scale, and they said he had not stayed 
more than twenty minutes in the bath: for which reasons, 
I have constantly made use of the fomentations and lini- 
ment, and omitted bathing, and I may add, with the de- 
sired success in general. 

In this case the pulse is generally small, languid and 
slow, only during the continuance of the convulsive 
spasms, and a minute after them, it is often small, quick, 
and irregular, but soon becomes slow again, and the pa- 
tient is usually rather cool than warm, especially his ex- 
treme parts, which are usually cold, and often covered 
with a cold clammy sweat; wherefore some warming 
cordial medicines are necessary to increase and keep up 
the momentum of the circulating fluids; as a little soft 
warm wine and water given several times a day, or some- 
thing of the following nature when sick or faint: as, 

§> aq. menthce simp, alexit. simp, ana §iv. vini Made- 
riens. vel canar. giiij. spir. lavend. c. gss. tinct. cast, 
spir. aromat. vol. ana 5IJ. syr. e mecon. §j. misce, dentur 
cochl. duo vel tria in spir. languorib. 

For it is necessary to support the patient with these, 
and the use of a cordial vinous diet, if they can get them 
swallowed, which in this case is often done with difficul- 
ty, as their jaws are close locked together, and swallow- 
ing even liquids is very painful and difficult; as, gruel 
with wine, and wine-whey made pretty strong of the 
wine; as it is absolutely necessary in this case, to keep 
up a moderate equal warmth all over the body, and a 
moderate warm breathing sweat also, for I have always 
observed that where this can be done, and kept up, they 
generally recover; and where this equal warmth and mod- 
erate perspiration cannot be obtained, but the extreme 
parts remain cold, and covered with cold sweats, they 
most commonly die. 

In this disease, the sick are generally costive, which is 
generally rendered more so, by giving such large and fre- 
quent doses of opiates, yet without which they can nei- 
ther live nor recover; wherefore an emollient relaxing 
clyster must be injected every other day, or oftener if ne- 
cessarv. As, 



PECULIAR TO THE W. INDIA ISLANDS, &c. in 

§> decoct, emol. pro clys. §viij. elect, lenitiv. ol. 
palmae christi, ana gj. bals. Peru v. 3J. pisselii indie, gj. 
misce, fi. enema. 

But neither purging, bleeding, nor any other evacu- 
ations are of any service, but on "the contrary are rather 
hurtful; except in a chance case, where the patient is of 
a plethoric constitution, as I once saw one who was so, 
and had been treated with very hot medicines, which 
had brought on some inflammatory symptoms, with 
pleuretic pains, and his blood was become sizy by taking 
such hot inflaming medicines; but by bleeding him 
once, and the use of antiphlogistic medicines, with the 
musk and opium at proper intervals, the fever and inflam- 
mation were taken oft', and the convulsions also, and the 
person soon recovered. But bleeding in this case, when 
from a puncture as this was, should be advised with great 
caution and judgment. 

When the opisthotonos and tetany proceed from ta- 
king cold, as before-mentioned, the patient is usually 
seized with all the same symptoms, as when they arise 
from a puncture or wound, and they usually come on in 
the same manner, first a pain in the head with a stiffness 
in the jaws, which after some time become close locked 
together and immoveable, then spasmodic contractions 
with acute pain at the scrobiculum cordis, or where the 
diaphragm, mediastinum pleura, and peritoneum meet 
and unite, these gradually extend to the muscles of the 
neck, and the spine, and so produce the opisthotonos, and 
lastly to all the anterior as well as posterior muscles, and 
those of the whole body, and produce a perfect tetany, 
so that the locked jaw, the opisthotonos, and the tetany % 
may be said to be the same disease, only more or less 
extended, and the tetany may be esteemed only a great- 
er and more universal extended degree of the former* 
But I must observe that when this disease proceeds from 
taking cold, it generally comes on sooner, viz. in three, 
four, or five days^ifter taking cold, and sometimes sooner, 
even the next night or day; but when from a puncture 
or wound, it usually comes on after the tenth day,, rarely 
sooner, sometimes not before the fourteenth day. And 



172 DISEASES, ACUTE AND CHRONICAL, 

though the symptoms are the same, and usually come on 
in the same manner in both cases; yet when it proceeds 
from taking cold, they not only come on sooner, but 
most commonly a small fever usually begins to appear 
about the third or fourth day after the locked jaw has ap- 
peared, and in some, increases and appears with some 
inflammatory symptoms in a few days more, which indi- 
cate and require bleeding; though their blood in this 
case is generally more florid, yet I never saw it covered 
with an inflammatory sizy pellicle. (79) 

The indications and intentions of cure are the same 
in this case as they are in the preceding, when from a 
puncture or wound; excepting the incision and what re- 
lates to the wound, which cannot be necessary nor used 
here; as also are the same methods and medicines, as 
the musk and opiates, fomenting and anointing the ri- 
gid and contracted parts, as, the_ prsecordia, the articula- 
tion of the jaws v neck, and spina dorsi, four or five times 
a day, and the use of all the other before- mentioned medi- 
cines. But as this arises from catching cold suddenly, 
by which the perspiration is obstructed and diminished, 
and the quantity of the fluids is increased, whereby more 
or less of a fever is produced, which is most commonly 
attended with some inflammatory symptoms, which ren- 
der it necessary to take some blood from the patient, 
more or less, accordingly as the symptoms indicate; and 
sometimes to give some antiphlogistic medicines, with 
the opiates and musk as before. 

This method I found to be the most successful, and it 
generally answers our expectations, when taken in time, 
and these medicines are suitably given; but when they 
are too long deferred, it most commonly proves mortal, 
as well as the former: and when the patient does recover, 
the danger is usually over in six or eight days time; yet 

(79) We see here a confirmation of the reason given in 
note 78, why the tetanus is attended with less danger when a 
portion oi its violence is communicated to the blood vessels, 
than when it is confined exclusively to the muscles. 



PECULIAR TO THE W. INDIA ISLANDS, &c. 173 

the stiffness of his neck and back generally continues 
for two or three weeks, and sometimes longer, before it 
goes entirely off. 

The opisthotonos and tetany, which seize young chil- 
dren in this warm climate, arise from the same causes, 
which usually produce the insultus epilepticus, or con- 
vulsions, in them in England, viz. a retention of the me- 
conium, or first excrement after the birth; or from a glu- 
tinous matter which is too often found in the intestines 
of young children, soon after the other is discharged; or 
from a cheesy matter from the coagulation of the milk 
by an acid in the stomach; or from hard excrements; or 
from something taken in by the mouth which is over 
acrid, or too hard to digest, which irritates their tender 
bowels, and so produce startings and convulsive spasms, 
with all the other symptoms which precede and accom- 
pany convulsions in young children in England; and 
shews how much more readily and easily the nerves are 
affected and irritated in that warm climate, and the teta- 
ny produced from a much less cause there, than it is in 
England, where it is but seldom seen: but these causes 
not being timely removed, their acrimony is increased, 
partly by the heat of the climate, and partly by the fe- 
ver which they produce, which still renders them more 
acrid, and so increases the iritation of their bowels, that it 
first brings on startings, then convulsive spasms, and re- 
gular convulsion fits, which, if not soon removed, usual- 
ly end in a perfect tetany, there, and is but seldom cured 
in such young children, when it arrives at that state: for 
when the child lays in this miserable, rigid, immoveable 
condition, upon moving its hands or feet in the most 
gentle manner, or softly touching any part of its body, 
or giving it the least motion, even feeling its pulse in 
the most gentle, tender manner, or the least noise, or even 
touching its clothes will bring on the convulsive spasms, 
and cause it to be strongly convulsed backwards, or drawn 
into a rigid straight line, strongly extended and immove- 
able like a statue, and will so .remain immoveable out 
of either of those postures, for a considerable time, a 
minute or two; and when the disease is arrived at this 



174 DISEASES, ACUTE AND CHRONICAL, 

degree, I think it is never cured. But if the physician is 
called in time, before the tetany has seized the child, 
(which is too seldom the case there, ) though he finds 
strong convulsive spasms have seized the child, or that 
it has had a convulsive fit or two, provided that the te- 
tany is not come on, it may most commonly be relieved, 
and the coming of the tetany be prevented, and the life 
of the babe be saved; as I have more than once seen, 
by removing and carrying off the irritating cause, which 
stimulates and irritates their tender bowels, by such gen- 
tle evacuations as are suitable to their tender age; and 
then quieting and composing the irritation of their nerves 
with suitable anodynes, and correcting the remaining ac- 
rimony of the nutricious juices, in the primes vias. 

To answer which intentions, I have found the follow- 
ing method, with variations pro re nata et pro ratione 
os talis, as the cause is different, to answer the desired 
effect the best. As, 

§, seri lactis gij. sapon. venet. 9j. mannas chalab. 31J. 
vel iij. oh amigd. dul. gss. fceniculi dul. gut. ij. bals. 
Peruv. gut. v. misce, fi. enema quam primum injicienda. 
And if the symptoms of the approaching tetany will 
permit, I usually give something of the following nature 
to assist the operation of the clyster, and to carry off the 
acrimony the sooner: §> aq. sem. funiculi 3 iij . magnes. 
albas. 3ss. ocul. cancr* praep. 5j. syr. e cichor. cum rheo, 
rosar solut ana Siiij. misce. vel, 5> aq. sem. focniculi 
^iij. sapon. amigdal. sss. magnes. albx 53s. syr. e ci- 
chor, cum rheo, mannas opt. ana 51J. oL amigd. dul. 
3iij. misce, exhibe cochl. parv. vel duo pro ratione aetatis 
omni semihora, vel omni hora, donee respond, alvus. 
Two or three stools being obtained by these) I gene- 
rally give something of the following nature, in order 
to abate the convulsive twitchings, and prevent the te- 
tany from coming on; JJ> aq. sem. fceniculi ^iij . mag- 
nes. albas 5ss. ocul. cancr. praep. 3j. moschi orient, gr, 
iij. spir. c. c. ver. gut. xv. syr. e mecon. ^ss. misce, 
exhibe cochl. parv. (a child's spoonful diet.) ter qua- 
terve de die, vel saspius, urgent, convuls. vel spasm 



PECULIAR TO THE W. INDIA ISLANDS, &c. 175 

But if the symptoms shew that the tetany is more 
immediately coming on, so that we have not time to 
wait till the operation of the clyster and opening laxa- 
tive be over, something of the following nature must be 
immediately given; or the tetany will come on, and 
most commonly proves fatal to such tender babes. 

$> aq. sem. foeniculi 3iiij. moschi orient, gr. j. tinct. 
thebaic, gut. iiij. syr. e mecon. 3ij- misce pro duobus 
dos. de quibus exhibe unam quam primum, et alter si 
convul. spasm, redeunt. 

This may be thought a bold attempt, to give tinct. 
thebaica to such a tender young infant; but as we are 
but too certain that it will die if the tetany seize it, and 
that it will come on if this do not prevent it; and I have 
known a bold ignorant old midwife give four or five drops 
of that tincture to a very young infant without any pre- 
judice, more than its dozing three or four hours, though 
not in this case, but in one much less violent; and we 
ought not to think it below us, to gather good from evil, 
or knowledge from the bold and ignorant, when we can, 
for the good of mankind in any case, as it is neither un- 
becoming a good man, or a philosopher. 

The clyster may be given at the same time, and the 
opening laxative not long after it, though it may retard 
the operation of that, for some time, yet it operates soon 
after, and gives relief; after which the other medicines^ 
and fomenting the body and anointing it, as before, may 
be used, if the physician finds it necessary; also a little 
of the laxative mixture may be given once or twice a 
day, if the above julep does not answer that intention of 
keeping the child's body open for a few days afterwards, 
which in this case I have generally found it necessary to 
observe. 

These methods and medicines may be varied accord- 
ingly as the causes of the convulsions differ, and the 
other concomitant circumstances of the patient may re- 
quire, as the attending physician sees it necessary; for 
neither the same method, nor same medicines, will an- 
swer in all cases, though the disease be the same, but 
they must be changed, as the causes differ, or the con- 



176 DISEASES, ACUTE AND CHRONICAL, 

stitution of the sick, or the time of the disease, or as some 
other circumstances may require; which is a thing of 
great importance, not only in this, but in the cure of 
most other diseases; wherefore I mention it here, chiefly 
to caution the practitioners in the West- Indies. 

And when proper medicines are thus timely and ju- 
diciously given in this case, they seldom fail to carry off 
the irritating cause, and quiet and ease the nerves, and 
remove the convulsions and spasms, and consequently 
prevent the tetany's coming on, and the death of the pa- 
tient. 

But if calling in the physician be deferred till the 
tetany has already strongly seized the child, as is too of- 
ten the case here, neither warm bathing, fomenting, nor 
these methods and medicines, nor any others whatever, 
as far as 1 have been able to observe, will remove it, or 
its causes, nor save the life of the little tender patient. 



PECULIAR TO THE W. INDIA ISLANDS, &c. 177 



OF THE RABIES CANINA, OR MADNESS FROM 
THE BITE OF MAD ANIMALS* 



THOUGH this disease is neither new, nor endemi- 
al or epidemical to mankind; yet it is so frequently 
seen in most hot countries, and especially in the West- 
India islands, that it may be said to be endemial to the 
dog-kind, and their bite infectious to mankind; and as 
the method of treating it, which is intended to be com- 
municated here, has hitherto been found to be always sue- 
cessful, I hope it will be a sufficient apology for my 
troubling the world with it here now, after so many 
learned authors in various nations, have written so learn- 
edly upon it. 

The great professor Bcerhaave has already treated so 
judiciously and learnedly on its theory, that I have noth- 
ing new to add to it. See his aphorisms, & 1128, &c. or 
his lectures on them, taken in short hand, and published 
by the learned baron Van Suieten. What I have to add 
here, chiefly relates to the prophylactic and therapeutic 
methods of cure. 



178 DISEASES, ACUTE AND CHRONICAL, 

The rabies caniiia, so called from the savage madness, 
which is caused by the bite of mad-dogs, hence also call- 
ed canine madness; and from its most terrible symptom 
of dreading water, it is also called hydrophobia, and by 
some hygrophobia. 

This disease, though indigenous in warm climates to 
the dog kind; always proceeds from a poisonous con- 
tagion taken into the blood of men, by the wounds made 
by the bite of some animal which was mad before. As of 
dogs, wolves, foxes, cats, apes, horses, asses, mules, oxen, 
sheep, swine, or fowls, which are mad; as also from men 
labouring under this disease, when they bite and wound 
those who attend upon them. But it appears from history, 
that dogs, foxes, and wolves, (which are all of the dog 
kind) are subject to this disease from immediate internal 
causes, without being bitten or infected by other animals; 
which most commonly arises from the long continued 
great heat of the climate, and great dryness of the coun- 
try, a want of water, and being ill fed, or from their 
feeding upon putrid, foetid maggoty meats, and some- 
times from worms bred in the kidneys, intestines, and 
brains, or high up in the nostrils of those animals.* 

And as great heats and dryness frequently continue 
long in these islands, and are sometimes attended with a 
scarcity of water, and that the dogs are often much starv- 
ed and ill fed, and frequently get putrid and maggoty 
flesh of dead animals, it is no wonder that those poor 
creatures frequently run mad, and then bite other dogs, 
and other animals, as well as men, which soon after be- 
come mad also; and thus this dreadful disease is too of- 
ten fatally propagated. (80) 



-*See Bonete sepulcret. anatom. de rab. can. torn. i. lib. 1. 

(80) From the enumeration of the causes of this canine 
disease, it appears to be nearlv related to the jail fever in the 
human species. It is no objection to great heat, dryness, and 
scarcity of water, or vitiated aliment, producing this fever in 
dogs, that they do not act uniformly. Cold, and miasmata are 
less uniform in their morbid effects upon the body, and yet 
vAio will deny their agency in the production of fevers? 



PECULIAR TO THE W. INDIA ISLANDS, &c. 179 

Wherefore I shall here carefully describe the symp- 
toms or signs, which generally seize those animals, es- 
pecially the dogs, when they have been bitten, or are 
otherwise become mad, that their owners may take prop- 
er care of, or destroy them, before they bite and infect 
others, and so propagate the disease. 

Not long after these animals, especially the dogs, have 
been bitten, by a mad dog, they first begin to look dull 
and sad, and endeavour to hide themselves, or seek a 
solitude in some dark or by place; seldom or never bark, 
yet will grumble and be angry with or fly at strangers, 
but yet know and will fawn upon their owners; they be- 
gin to refuse their meat and drink, or just slightly taste 
them; they droop and hang down their ears and tail, look 
very dull and sleepy, and often lay down; this is the 
first degree of the disease, and their bite now is dange- 
rous, but not always infectious. Soon after this, they be- 
gin to breathe quick and heavily, then gape and shut 
out their tongue, and discharge much slaver and froth from 
their mouths, and looking as if half asleep they suddenly 
fly at the by-standers, then run forward, not in a straight 
but in a crooked line; these symptoms increase, and they 
begin not to know their owner; their eyes look exceeding 
dull and dusty, and much water runs from their eyes 
like tears; their tongue is of a lead colour, they grow 
weak and often fall down, then rise and attempt to fly at 
something, grow mad and furious: this is the second and 
last degree of the disease, which seldom continues above 
thirty hours before they die. Their bite, during the se- 
cond state of the disease, is commonly said to be incura- 
ble, and the longer it has continued the more furious 
their madness; and the nearer they are to their death, 
the more dangerous and more fatal their bite is, and the 
sooner it produces its symptoms and direful effects.(81) 

Scarce any poison known, is so infectious, or so easily 
and readily communicated by so many and various ways 

(81) There can be no doubt of the saliva being more or 
less disposed to produce the disease, in proportion to its grade 
or stage in the diseased animal. 



180 DISEASES, ACUTE AND CHRONICAL, 

as this of a mad dog is; for the slightest bite, only tear- 
ing the skin, without drawing blood, or the smallest 
quantity of the slaver of the mad animal, either fresh, or 
dryed for some time, taken upon the tongue or lips,* or 
rending a persons clothes and leaving the slaver on them 
to dry, has produced this disease; as a womanf had her 
coat torn by a mad dog, which she a considerable time 
after sewed up, and bit off the thread with her teeth, and 
sometime after died rabid from biting off that thread. 
Also a man only kissing his children to take his leave 
of them, when he had the rabies upon him, they all soon 
after died rabid.J Kissing a favourite dog that was mad, 
had the same effect; and a small wound received from a 
sword which had killed a mad dog a considerable long 
time before, has produced this most fatal disease. (82) 
Hence we see that we cannot be too cautious in avoiding 
this infectious poison; nor too careful in burning such 
infected or torn garments, or in carefully cleaning such 
knife, sword, or instruments as were used to kill such 
mad animals with; neither in using the utmost care to 
avoid getting any the least particle of such infectious sa- 
liva into or near our mouths, or on any excoriated or 
wounded part of our bodies, though ever so slight, and 
immediately to wash them in salt water and vinegar. 

However, we do not find from any history, that this 
poison infects us through the skin;§ but it may be pru- 
dent to wash such a part with salt water and vinegar, to 
take all the slaver off. 



* Celius Aurelian. de morb. acut. lib. iii. 

| F. Hildanus Obs. Chirurg. cent. i. 

$ Palmarius de Morb. Contagios. p. 266. et Schenkii, Obs. 
Med. p. 848. 

(82) More accurate observations prove that the disease can- 
not be communicated by the saliva unless it be conveyed into 
the system by means of a wound, or within the action of the 
lymphatics by the abrasion oi the skin. 

§Paul. iEginet. lib. v. ch. 3. /Etius, Tetrabit. lib. vi. c. 
24. Sauvages stir la rage, p. 5. 



PECULIAR TO THE W. INDIA ISLANDS, &c. 181 

Neither do we know any poison or infection, which 
produces such terrible effects, in so short a space of time, 
as this has been known to do, and at other times to lay so 
long dormant or hid in the body, without any pain till it 
was brought into action, and then produced its most dread- 
ful effects, as this poison is said to have done: for history- 
informs us, that some have been seized with its dreadful 
symptoms in a very short time after they have been bitten,* 
others have continued well for twenty years,f and then 
were seized with them, and died hydrophobous; and oth- 
ers again have been seized with it at all the intermediate 
times between these.J Hence we see that this poison 
sometimes enters into action very speedily, and on the 
contrary that at other times it lies dormant many years, 
and then proves suddenly destructive, when it is once 
roused into action. 

I shall first describe the symptoms of it, when it seizes 
men. A person in perfect health, being infected with 
this canine contagion, is sooner or later seized with the 
following symptoms, and in the following order. First, 
The part which was woundecJi or where the contagious 
poison was first fixed or given, begins to be painful, then 
wandering pains gradually spread round it, and so to 
other parts of the body; a weariness, heaviness, and inap- 
titude to motion through all the muscles follow; their 
sleep is disturbed with frightful dreams, accompanied 
with great startings and convulsive spasms; great restless- 
ness, and continual tossings of the body, sighing, sorrow- 
fulness, and a desire of solitude; these symptoms usu- 
ally attend the first beginning of the disease, and con- 
tinue to the end of the first stage of it: blood being now 
taken from a vein, has all the signs of health in it.(83) 

* Stalpert Vander Wiel Observ. Rarior. p. 413. 

f Du Choicels de la rage. 

jSchmid. in Miscel. Curios. Dec. 1. ann. 9. p. 119. 

(83) This disease, like the tetanus, owes its danger and mor- 
tality, to its being confined to a single system, that is the 
nerves. It has occasionally yielded to medicine, where it has 
diffused itself to the blood vessels. 



182 DISEASES, ACUTE AND CHRONICAL, 

This state continues in some a longer, in others a shorter 
time, and then they enter upon the second stage of the 
disease, in which all the above symptoms are increased, 
with the addition of a violent oppression at the prse- 
eordia, a great difficulty of breathing, with sighing; 
great horror and dread of mind; which is increased up- 
on the sight of water, or other liquors, or the face of a 
looking glass, as it resembles water, with great tremors: 
a loss of appetite, yet they generally can swallow soft, 
solid food or medicines; but touching any kind of liquids 
gives them intolerable anxiety, with great tremors and 
Convulsions, and often throws them into raving mad- 
ness: they vomit a glutinous, brownish, bilious matter, 
or a porracious bile; a fever, with great inward heat and 
thirst comes on, attended with continual w r atchings, and 
sometimes with a priapism; very disturbed and unusual 
rambling thoughts, and sometimes ravings; and thus con- 
tinues and ends the second stage of the disease. But af- 
ter this, all the above-mentioned symptoms are contin- 
ually aggravated and increased, the tongue becomes dry 
and rough, and is often \hrust out of the mouth; the 
voice becomes hoarse, and the thirst almost inexpressibly 
great, yet cannot drink any thing, because now on the 
sight of, or attempting to touch any liquor, they are strong- 
ly convulsed and thrown into a raving madness: a great 
quantity of frothy saliva is collected in their mouths, 
which they cannot swallow, but endeavour to spit out 
upon the by-standers, even against their inclinations when 
they are more sensible; with a desire of biting those 
they can come at, though often contrary to all the force 
of their will; (84) they rage and foam at their mouths; 

(84) Unreasonable fears have been entertained of the dis- 
ease being communicated by persons affected with it, biting 
their attendants. The disease is generated only in dogs, wolves, 
cats, foxes, and perhaps hogs. When communicated by them 
to the human species or to cattle, sheep and horses, there is 
not, the editor believes, a single instance of its having been 
communicated by them to any other animal, by biting or in any 



PECULIAR TO THE W. INDIA ISLANDS, &c. 183 

their pulse sinks, and their breathing fails; cold clammy 
sweats come on; they are raving mad, yet have intervals 
in which they are rational and speak prudently, and are 
fearful of hurting others who are present. And thus most 
commonly, death with a suffocating breathing, and con- 
vulsions, puts an end to their then miserable life, within 
the fourth day from the first stage of the disease* 

Having thus plainly described this disease, and its most 
remarkable symptoms, by which it may be certainly 
known, both when it seizes dogs, that they may be de- 
stroyed ; and also when it seizes men, when they have the 
misfortune to be bitten by any mad animal, and are seized 
with it, so that it may be known to be this dreadful dis- 
ease, and that they may apply to proper assistance, before 
it be too late, 

I shall not enter any further into the theory of this dis- 
ease, than is absolutely necessary to explain my reasons 
for proposing what I may hereafter recommend: as that 
is already done by a more able hand.* Neither shall I say 
any thing more relating to the nature of this subtle and 
deleterious poison, or its manner of acting, so as to pro- 
duce its direful effects ; as so many able physicians, 
both ancient Greeks and Arabians, and many learned 
moderns, have so learnedly and judiciously treated on this 
subject.f From which the diagnosis of this disease may 
be certainly known, though the prognosis of its conse- 
quences and effects are not so certainly known as we could 
wish them to be : since all the greatest professors of our 
art, have lamented, that even in its present improved 
state, it has scarce once furnished us with a certain pro- 



other #ay. The milk of cows, and the flesh of hogs, have 
been eaten with safety a few days before they died of the dis- 
ease. 

* In profess. Bcerhaave's aphor. de cog. et cur. niorb. and 
m his lectures published by the learned baron Van Swieten. 

f Boerhaave in locis cit. Mead on poisons. Tulpius ob. med, 
Salius tliversus, Stalpart Van der Vyielen, Sauvages, philos. 
transact, memoir, de Pacad. des scienc. xniscellan. curios, acta, 
physico-medic. Curiosor. &c. &c. 



184 DISEASES, ACUTE AND CHRONICAL, 

phylactic, or real preventive cure of those who have been 
bitten by a real mad animal; and affords us not one single 
instance of a cure, that can be certainly relied upon, after 
the dread of liquors has appeared and seized those pa- 
tients ! as the great Bcerhaave has judiciously observed; 
and adds, u It is much to be lamented, that after so many 
ages past have been thus deplorably sensible of the 
fruitless insufficiency in all their former known methods, 
they should still neglect the trial of new ones, different 
from those of their predecessors.' 5 * 

To say any thing on those, or any other how much so- 
,ever extolled nostrums, is unnecessary; unless we can 
introduce something that is new, and produce certain un- 
deniable instances of their success, so as that they may 
become useful to mankind. I shall therefore, after describ- 
ing the state in which the bodies of those who died of 
this disease, have been found upon dissection; and then 
relate the prophylactic method of cure, which I have 
used, and found to be successful, after the persons have 
been bitten by mad animals, but before the hydrophobia 
came on. And then say something on the therapeutic 
method of cure after those fatal symptoms are come on; 
and shall candidly relate such cases as were very remark- 
able, and have fallen under my own observation, with 
fidelity. 

From dissecting bodies who died of this disease,! we 
are informed, that the organs of swallowing are usually 
in an inflamed state; that a viscid glue-like bilious 
matter is found in the stomach; the gall-bladder filled 
with black bile; the pericardium quite dry; the lungs in- 
credibly stuffed up with blood; the heart filled with blood, 
which is often found almost dry; the arteries filled with 
blood; the veins almost empty; and their blood very li- 
quid, and will not coagulate in the air, though it con - 

* Bcsrhaave's lectures on his aphorisms, by the baron Van 
Swieten, de rab. canin. * 

f Boerhaav. aphorism, de cog. &c. bonet. sepulemet. anatom. 



PECULIAR TO THE W. INDIA ISLANDS, &c. 185 

creted but three days before when taken from a vein; 
all the muscles, viscera, brain, cerebellum, and the spi- 
nal marrow, are found much drier than usual. 

From whence I beg leave to observe, that although an 
inflammation of the organs of swallowing usually, but 
not always, is found in such dead bodies; and that 
inspection into the fauces and throat, informs us, that an 
inflammation of those parts is never found in the begin- 
ning of the disease, and very seldom, even some time 
after the patient has been unable to swallow any liquids, 
and in some, not even at the last; so that it is not an in- 
flammation and swelling of the parts that hinders their 
swallowing, but the convulsive spasms of those parts. 

Hence we conclude, that though the first cause or bite 
may be in the remotest part of the body, yet the conta- 
gious poison, when it begins to act, and exerts its poison- 
ous force, it chiefly affects the nerves of the gula, and 
the muscles employed in deglutition, which it so greatly 
irritates, when they are moved, as to cause violent spasms 
and convulsive contractions in them; from whence pro- 
ceeds that impossibility of swallowing any liquids what- 
ever: and both that glutinous matter in the stomach, and 
the great dryness in the blood, heart, and other parts 
above-mentioned, proceed principally from a want of a 
supply of liquids to dilute them, increased by the in- 
ward heat, and continual waste of the fluids, by saliva, 
urine, perspiration, and sweat: and the inflammation of 
the gula and the muscles serving for deglutition, which 
is found in some patients, but not in all, arises from the 
want of that supply of liquids, and dryness of the blood, 
and the frequent convulsive spasms of those parts: hence 
we must conclude, that this inflammation of those parts, is 
not the cause of their inability of swallowing, but is the 
effect of the above-mentioned causes, and the often re- 
peated convulsive spasm of those parts. 

As all the histories of this disease, give us so many 
dreadful accounts of its most fatal effects, we cannot be 
too careful and assiduous in using all prudent methods 
to prevent them, when any person has the misfortune to 
be infected with its poison; for I believe that no man who 

« A a 



186 DISEASES, ACUTE AND CHRONICAL, 

has seen the dreadful issue of this disease, but would 
readily prefer a maiming, if irot the loss of a limb, to 
save his body from so calamitous a death. 

^ Wherefore, when any person has the misfortune to be 
bitten by a mad animal, if a surgeon or an apothecary 
be near, it is undoubtedly the safest and most prudent 
method, immediately to cut the bitten part clean out, (if 
it be in such a part of the body, that it can be safely done,) 
then apply a cupping-glass over that wound as soon as 
possible after, in order to suck out as much of the poi- 
son with the blood, as you possibly can; after which cau- 
terize the bottom and all the sides of the wound with an 
actually cautery, and dress it with a proper digestive; 
then wash the wound every day with salt-water and vine- 
gar, and keep it open with gentle escarotics for a con- 
siderable long time, that it may discharge, as much of 
the poison as possible. But if the part bitten be such that 
it cannot be safely cut out, let it be gently scarified near 
the wound, then cupped and cauterized, and dressed, 
washed, and kept open as above, or cauterized without 
scarifying.(85) 

Also great care should be taken that the garments of 
the person, if torn, or the least daubed with the slaver 
of the mad animal, be burned, and the rest of it be 
carefully clean washed: also that the straw, trash, or bed- 
ding, on which the negro laid, spit, or slavered, be burn- 
ed; or the trash on which the mad animal laid, slavered, 
or on which it was killed, be carefully burned, and the 
place clean washed; and the sword or instrument with 
which it was killed, be carefully cleaned; for we have in- 
stances of cattle eating such straw sometime after on 
which the mad animal had laid, and dying mad soon af- 
ter, by eating that straw. 



(85) Cutting out the bitten part has generally prevented 
the disease. There is good reason to believe it will prevent it 
if performed at any time before the symptoms of the disease 
make their appearance. Where the knife has been objected 
to, frequent ablutions with water, also caustics applied to the 
wound, in a diluted state have been employed as preventives 
with success. 



PECULIAR TO THE W. INDIA ISLANDS, &c 187 

This being done, (or where all these operations have 
been neglected to be done) if the patient be of a pletho- 
ric constitution, and has lost little blood by cupping, I 
usually order some blood to be taken from them, and if 
their stomachs be foul, a vomit to be given (if not, 
it is not necessary,) that evening, and a musk bolus of 
the following nature after it when going to bed; with di- 
rections to encourage moderate sweating that night, by 
drinking small wine-whey warm after it. 

§, moschi orient, gr. xvi. cinnabar, nativ. levig. gss. 
vel ^ii. pil. saponac. gr. viij. camphorii gr. vi bals. Pe- 
ruv. q. s. misce, fi. bolus. 

And the next morning I usually give an antiphlogistic 
purge, and in the evening after, I most commonly order 
the patient to bathe in the sea, (or if that is at too great a 
distance, in a cold bath, or a river,) and either plunge him- 
self, or be plunged by the hands of another person, quite 
over head, and detained under the water some time; and to 
repeat that two or three times, then come out and be rub- 
bed dry, and go into bed, and take the musk bolus as 
above, and drink half a pint of the infusion of rad. va- 
lerian, sylvest. cort. sassafras, and as much warm small 
wine-whey as he pleases after that, and encourage mode- 
rate sweating all that night; and to repeat the bathing 
in the sea, and the musk bolus after it; as also the infu- 
sion and warm whey every night, for three or four nights 
more successively, with moderate sweating each night. 
And if the animal which bit them, was in its last state 
of madness, or was very rabid or raging when it bit them, 
I order them to repeat all the same, for six or seven 
nights more successively; and also to repeat all the same 
for three nights at the next full, and the next change of 
the moon following. For I have observed frequently, 
that several persons (though not all) who were bitten by 
mad animals, were more disordered, and were seized with 
a heaviness, dulness, and a love of solitude, at the full 
and change of the moon next following after their being 
bitten, though it went off, and they recovered by these 
methods and medicines,, and they became perfectly well 
after. 



188 DISEASES, ACUTE AND CHRONICAL, 

I have also generally advised these patients to go into 
the sea or cold bath, the last morning after this bathing 
and sweating; then to rub themselves dry, and put on 
their clothes without sweating, and go about their busi- 
ness or pleasure, in order to prevent their taking cold, 
and bringing on a fever, which might be of bad conse- 
quence at this time. 

I am sensible that this prophylactic method of cure 
differs considerably, in several respects, from that recom- 
mended by my much esteemed and learned master pro- 
fessor Boerhaave; and also from that of several other lear- 
ned physicians, who have all recommended bathing in 
the sea, but to be performed with such a bustling terri- 
fying apparatus, as to excite a dread and fear of suffoca- 
tion in the patient; and the repeating those immersions 
several times in order to increase that terror, though he 
both threatens and supplicates the performer to the con- 
trary, as the Dutch sailors have been taught, and usually 
do. And both they* and that learned professor,f tell us, 
that it generally was so successful in effecting a cure ? 
that it seldom failed; and I remember that he in his lec- 
tures on his aphorisms^ usually gave us several histo- 
ries of cases in which it was successful; but he also gave 
us some in which it did not succeed, and they died hy- 
drophobous afterwards. 

But they seem to ascribe too much to the terror and dread, 
which the patient is put into by such a frightful apparatus; 
nor can I conceive how exciting such a dread, can be of 
any service, or any way contribute to the cure in this case, 
where the dejection of their spirits, and great dread which 
always attends this disease, are already too great before, 
without the addition of such a frightful apparatus; unless 
it acts by causing them to sweat more copiously after it- 

*Tulpii Observ. Med. L. 1. Cap. 20. p. 41. Stalpart Van 
der Wielen Cent. 1. Obs. 100, &c. Dekkers Exercit. Pract. 
p. 564. 

f Ridley. Observat. de Asthm. et Hydrophob. Ob. 25. 

{ Vide Baron. Van Sweiten, in Aphor. H, Bcerhaavi, vol. iv. 






PECULIAR TO THE W. INDIA ISLANDS, &c. 189 

But we can more rationally account for the producing 
a copious sweating after cold bathing, and its being of 
great service in this case: since we know that cold im- 
mersion braces up and gives a greater spring to the so- 
lids, and causes them to act with greater force on their 
contained fluids, and so increasing their momentum, 
which will not only attenuate them, but may contribute 
to comminute and break the morbid viscid poisonous 
matter also, (especially if they dilute plentifully, with such 
a saponaceous liquor as whey is, at the same time;) and 
all these causes thus jointly acting, may probably greatly 
contribute to cast the morbid matter out of the body by 
such copious warm sweats, as we frequently see are pro- 
duced after cold bathing, especially when assisted by the 
above methods and medicines. And I believe that it is 
from these causes, thus acting, that cold immersions 
have been found to be of so much service in the prophy- 
lactic cure of this disease; and I apprehend that if those 
learned gentlemen had been with their patients when 
they bathed, and made their observations with greater 
accuracy, in respect to their sweating more or less alter it, 
they would have found that those who had the most free 
continued warm, copious (not profuse) sweats, received 
the greatest benefit from it, and that those who did not 
so, received the least; because I think that I have found 
it so, at least in several cases, which have fallen under 
my own observation; some of which I shall now relate. 
A gentlewoman's two sons, her housekeeper, and seven 
negroes, were all bitten by a mad dog, in one morning; 
a month after which the housekeeper died hydrophobous: 
this alarmed the family, and they sent for me the next day; 
her eldest son, eighteen years old, was of a sanguine 
healthful constitution; the younger had a weaker consti- 
tution; they were both bitten in their legs, though not 
very deep; but their wounds were both healed up and 
cicatrised two weeks before I saw them, and they were 
seemingly well. They did not tell me that the negroes 
were also bitten, nor did I know it till afterwards. 

The eldest son being more plethoric, was bled, the 
younger was not, they were both purged the next morn- 



190 DISEASES, ACUTE AND CHRONICAL, 

ing; then bathed in the sea, being near it, and took tht 
musk and cinnabar boluses, as above, (the younger had a 
little less quantity of them both, he being but thirteen 
years old) and encouraged moderate sweating, &c. as 
directed. And five of the seven negroes that were bit- 
ten by the same dog, had the same medicines given to 
them, as I had prescribed for the eldest son, they being 
men, and were treated in the same manner; and both her 
sons, and all these five negroes have continued to be very 
well, without having any symptom of this disease ever 
since which is now ten years ago.(86) But the poor hired 
negroes, neither had any medicines or any thing done for 
them, unless they bathed, and both died rabid, about two 
months after the housekeeper died. 

Here three of the ten persons, who were all bitten by 
the same mad dog, near the same time, and had no as- 
sistance nor medicines given to them, all died rabid and 
hydrophobous; and all the seven persons who took the 
medicines and were treated as above, all remain free 
from any symptoms of this disease, and continue to 
enjoy health. This is an experiment which humanity 
would forbid any man to make; and if I had known the 
state of those two negroes, I would have procured them 
medicines at my own expense, but was not acquainted 
with their being bitten. However it serves to strongly 
prove, and greatly confirm the efficacy of this prophylac- 
tic method of cure. 

Not long after this, a worthy lady of great merit had 
thirteen of her negroes bitten by a mad dog, who, by 
the best account that I could obtain, was in the last 
stage of his madness when he bit them. They were all 
treated in the before-mentioned method, with variations 
pro ratione <etatis, &c. of the musk and cinnabar, &c. and 

(86) From the effects of depleting remedies in lessening 
ihe violence of the small-pox, and in preventing the yellow 
fever after the seeds of the disease are received into the body, 
there is good reason to believe the prophylactic method of 
preventing the disease, mentioned by our author, was attended 
with the success which he ascribes to it. 



PECULIAR TO THE W. INDIA ISLANDS, &c. 191 

have all continued perfectly free from any symptoms of 
this disease, though it was several years sinqe. And I could 
mention several more who had the misfortune to be bit- 
ten by mad dogs since, and by the same methods and 
medicines, have hitherto escaped entirely free from any 
appearance of this disease; neither have I ever yet seen 
any who pursued this method regularly, that have ever 
had any appearance of this disease afterwards; which in- 
duces me to reccommend this method of prophylactic 
cure to others. 

I must further observe, that in most of the above-men- 
tioned patients, the wounds made by the mad dogs were 
healed up, and well, sometime before any applications 
were made; those few whose wounds were not healed 
up, had them washed twice a day with salt-water and 
vinegar, and then dressed with a common digestive till 
well. Neither did I make use of any mercury, either inter- 
nally or externally, but the cinnabar, which is ore of mer- 
cury, though it has been strongly recommended by several 
learned physicians,* who have given us several accounts 
of its good success, but generally when it was used with 
other medicines at the same time. But the same learned 
authors also mention several cases, wherein mercury was 
used very liberally both internally and externally; yet it 
did not succeed but the patients died rabid after; so that 
it does not by any means merit the name of an infallible 
antidote. 

Neither durst I wholly depend upon the assertion of 
the Chinese, though they say, that musk and cinnabar 
is an infallible remedy in this case. Their method of 
giving them is, moschi gr. xvj. cinnabar, factitii, nativi 
ana ^j. misce, fi. pulv. which they give in a little arrack, 
and if it does not cause the patient to sleep and sweat, 
in three hours time, they repeat the dose, w T hich always 
procures sleep, and a copious sweat, as sir George Cobb, 
who first brought an account of this remedy from China,, 
informed me, which was about the time that the great 



* Desault Dissert, sur la rage. Sauvages diss, sur la rage* 
Philos. transactions. 



192 DISEASES, ACUTE AND CHRONICAL, 

Bocrhaave died, and it is probable that he had not heard 
of, as he has said nothing of it in this case; but the learned 
baron Van Swieten has added an account of its effects, 
to the lectures on the rabies canina of that great author, 
as also on mercury. 

But the extraordinary effects, which I had many times 
seen from giving musk in convulsive cases, and particu- 
larly in violent hiccoughs, which are a convulsive spasm 
of the sesophagus; and this disease being attended with 
violent convulsive spasms of the superior parts of the 
oesophagus and the mucles serving for deglutition, 
were greater motives for my giving it, than the re- 
commendations of the Chinese, because as much has 
been said of the efficacy of several other antidotes and 
nostrums. But I must add, that giving the musk has 
hitherto answered my wishes and expectations; and I 
cannot but ascribe much more to the virtues of the musk 
than to the cinnabar, though it may probably contribute 
something; but from what observations I have made, the 
musk seems to do much more by its subtle parts, both 
attenuating the circulating fluids, and the poisonous 
matter also, and so carrying it out of the body, by those 
copious warm sweats, which it usually produces, especi- 
ally when it is assisted by increasing the vis vitas and 
momentum of the fluids, by the previous cold bathing, 
just before they take it, and go into bed, to encourage 
that sweating; and by repeating it four or five nights 
successively; and as I have found this method so success- 
ful, I cannot but recommend it to others. 

Having said thus much on the prophylactic method of 
cure, I shall now say something on the therapeutic, or the 
method of cure when the symptoms of the disease have 
already seized the patient ; and the sooner the cure is at- 
tempted, after the first appearance of its symptoms, in the 
first stage, the better, and the more likely it is to prove 
successful, as the great Bcerhaave justly observes;* 
i Curatio verb morbi jam presentis videtur tentanda, max- 

* Bcerh. Aphoris. de Cog. et Cur* Morb. Aph» 1144. 



PECULIAR TO THE W. INDIA ISLANDS, &c. 1&3 

ime in primo gradu ; et in initio secund. (1138) impri- 
mis quum aliter funestissimo exitu neglectus plectatur. 
— 1. Statim post prima signa invadentis mali (1138) 
morbus tractandus, ut summus inflammatorius, mittendo 
sanguine m ex lato vulnere magni vasis ad animi deli- 
quium usque,' &c. 

But inasmuch as the hydrophobia arises first from the 
convulsive spasms of the gula and organs of swallowing, 
and not from an inflammation of those parts ; neither is it 
any inflammation or swelling in them, that hinders them 
Ifrom drinking liquids, but the convulsive spasms of them, 
which being often and violently repeated, together with a 
want of a supply of diluting liquors, that produces an 
inflammation of those parts at the last ; hence we discover 
that the inflammation is the effect, and not the cause of 
the hydrophobia. But as bleeding may prevent the inflam- 
mation's coming on, and abate those spasms, it may be 
necessary in a moderate degree ; and when the disease is 
further advanced, it is necessary in a much larger quan- 
tity; and I have found it to be of very great service. But I 
think still that the principal part of the cure, depends upon 
the effect of the antispasmodics, especially the musk, and 
their attenuating the morbid matter, so as to fit it to be 
carried out of the body by free copious sweating, espe- 
cially in the prophylactic cure, as also in the beginning of 
the second stage of the disease ; which the following cases 
seem to confirm. 

A young gentleman near eighteen years of age, was 
bitten by a mad tame fox, who was bitten by a mad dog 
some time before ; the wound was four inches above his 
heel, and bled a little, but was healed up in two weeks 
time. But the next following new moon, he appeared to 
be very dull, heavy, and much dejected, but these went 
©ff in three or four days time ; but the next full moon all 
these symptoms returned in a greater degree, joined with 
a strong desire of solitude ; that night he did not sleep 
much, and that much disturbed ; his father desired him to 
rise, which after some time he did, but put on his clothes, 
and hid himself in a dark place under the roof of the house, 
and said, he could not bear to see any company, and was 
not willing to see me when I crime there, though well ac- 



t#4 DISEASES, ACUTE AND CHRONICAL, 

quainted with him, neither would he see any other com- 
pany ; I went to him, and told him that he was not well, 
and desired him to tell me how he w r as, and if the fox 
had not bit him ; he said, yes; but there was nothing in 
that, the place was well two weeks since, and he well after 
that, but now he had an uneasy sensation and weight at 
his stomach and breast, was greatly dejected he knew not 
why, and desired to be alone ; I then took him into a pri- 
vate room, and found that he had all or most of the symp- 
toms of the first state of this disease, (though he was 
naturally of a cheerful disposition) and found that his 
disorder solely arose from the bite of the mad fox, who 
had made his escape. I ordered §xviij. of blood to be 
taken from him immediately, gave him a vomit in the 
evening, with which he drank green-tea plentifully, and 
the following sudorific bolus at bed-time, and warm 
wine-whey after it, and encouraged a warm breathing 
sweat all that night; for the extraordinary virtues of musk 
in this case, were not known in England at that time, nor 
till some years after. 

§> Mas. pil. saponac. gr. x. sal. succini vol. campho- 
rii ana gr. viij. tartar, regenerat. theriac. androm. ana 
9j. ol. sassafras gut. ij. bals. Peruv. q. s. misce, fi. 
bolus. 

The next morning he took an antiphlogistic purge 
which purged him pretty briskly, and repeated the same 
bolus the night after it; he slept well and sweated freely 
both these nights, and was much better the next day; he 
went to Scarborough the day after, where he drank the 
cooling, nitrous, purging waters of that spaw every morn- 
ing, and bathed in the sea every night for five or six nights, 
and then every other night for three weeks more, and 
went to bed after bathing and took the above bolus, and 
drank warm whey, and encouraged moderate sweating 
after it, and returned home perfectly well, and has contin- 
ued so ever since, which is now above twent)'-six years 
ago. 

A young man about twenty years of age, was bitten by 
a mad dog, and neglected to do any thing for it, and was 
at the full moon following seized in the same manner as 
the gentleman above : these symptoms also went oft' after 



PECULIAR TO THE W. INDIA ISLANDS, &c. 195 

three days, but returned the next full moon following, but 
considerably aggravated and increased : he then came to 
me; and finding his case to be near the same as the other 
gentleman's, except that the load and oppression at his 
stomach was less, and he had more pain in his head; I 
advised the same method as above, except the vomit, and 
repeated the purge two or three times ; as he did not go 
to Scarborough, he went into a cold bath, and took a 
sudorific bolus, as above, and an infusion of valerian and 
sassafras after it; and encouraged a free perspiration, with 
moderate sweating after it, by drinking warm whey after 
them every night, for near two weeks, and was then well: 
I saw him some months after perfectly well, and have not 
seen or heard any thing from him since- 

These two cases were taken at the first beginning of the 
symptoms, in the first stage of the disease, before any ap- 
pearance of the hydrophobia came on ; and by this atten- 
uating sudorific method, it and its dreadful effects w r ere 
prevented from ever coming on: but I must add, that I 
should now prefer giving the musk and cinnabar as above, 
from the many extraordinary effects which I have since 
seen them have. 

Three years after this, I was called to a barber's wife 
above twenty miles from me, but being pre-engaged to 
go ten miles the contrary way ; and the apothecary hav- 
ing described her case and constitution very well, I gave 
the following directions, as I could not see her in time e 
She had a pretty good constitution, though not robust and 
strong ; and was bitten by a mad dog near three months 
before. She was seized with the first symptoms of this 
disease, four or five days before they sent to me, which 
increased, and the hydrophobia with the other symptoms 
of the rabies came on, the day before they sent for me, 
she could neither drink, nor bear the sight of any liquors 
for some hours before the messenger set out on the jour- 
ney; and the rabies was so great, that the attendants had 
bound her hands and feet to the four posts of the bed 
on which she laid; so that the hydrophobia had been 
upon her above thirty hours, before the following medi- 
cines were administered. 






196 DISEASES, ACUTE AND CHRONICAL, 

I ordered her to be bled fere ad deliquium animi, and 
added to bleed her as long as they could, not to let her 
die away; then two hours after, to plunge her into a 
large tub of cold water, and to immerge her quite over 
head two or three times, and to detain her under the water 
each time, as long as they could, not to drown her; then 
to take her out and rub her dry, and put her into bed, 
and give her the following soft sudorific bolus, without of- 
fering her any liquids with it, or for two hours after it; 
which she took and swallowed with a little difficulty; for 
they can often swallow a soft solid substance as food, 
when they can neither bear to see, or take any liquids* 

§> theriac. androm. Jss. pil. saponac. sal. succini vol. 
ana 3ss. camphorii pulv. gr. viij. ol. menthee gut. i. syr. 
e mecon. q c s. misce, fi. bolus molli, ut supra sumend. 

And three hours after that, or sooner, if the opiate 
began to affect her, so that she could bear the sight of 
any liquids, to give her a draught of an infusion of rad. 
valeriani, cort. sassafrae, with sal. nitri, sal. diuretic, sweet- 
ened with a little sugar, and as much w T arm small wine- 
whey after that, as often as she would drink; which she 
now took and drank with tolerable ease: and in two hours 
time after the first draught, viz. about four or five hours 
after the bathing, having sweated most of that time, she 
fell asleep, and slept four hours, and sweated freely all 
that time, then awaked very sensible and calm; and as 
she now could drink liquids with ease, she took a 
draught of the above infusion every three hours, and 
drank off the warm whey very plentifully, and conti- 
nued the warm breathing sweat forty-eight hours, as I 
had ordered, and repeated the bolus three times in that 
time. An antiphlogistic cathartic was given her the 
morning following, which purged her well, and she con- 
tinued to dilute plentifully with whey, and repeated the 
bolus that night after the operation of the purge; she 
slept very well that night and appeared to be very well 
the next day, only she was weak and low from such large 
evacuations; but that was soon relieved, and her strength 
restored by a suitable cooling, diluting, and nutritious 



PECULIAR TO THE W. INDIA ISLANDS, &c. 197 

diet, which she took and perfectly recovered: and I saw 
her about seven years after that, in perfect health. 

The first steps towards this cure were made by the 
large bleeding(87) and giving the opiate, which greatly 
contributed to take off the convulsive spasms, and so 
enabled the patient to drink diluting liquids copiously, 
whereby the almost dried circulating fluids, were diluted 
and attenuated; and this being seconded by cold immer- 
sion, by which the momentum of the fluids must be in- 
creased and attenuated; which being assisted by the vol- 
atile, attenuating, saponaceous medicine, and diluting 
plentifully with such a saponaceous liquor as whey is 
known to be, must jointly contribute not only to attenu- 
ate the circulating fluids, but the morbid poisonous mat- 
ter also, and so carry it out of the body by the long con- 
tinued, free, warm sweating, as was above advised. At 
least these were my reasons for directing this method of 
cure, to which what the great Bcerhaave has said concern- 
ing bleeding largely, and cold bathing in this case was 
not the least motive to it: this however seems to be the 
most rational way of accounting for their effecting this 
extraordinary cure in so short a time. 

The extraordinary effects of musk when given in large 
doses, in this and some other convulsive spasms, were 
not then known in England; and as I have always 
found the above prophylactic method of cure so success- 
ful, that I have not had an opportunity of seeing any 
one hydrophobous since the above patient; otherwise 
I should have given the musk with the opium, sal. suc- 
cini & camphor, instead of the theriaca, because I think 
it is a much preferable, and every way a better medicine 
in this case. 

And as musk is found by experience, to be so effectual 
a remedy, in the prophylactic cure of this disease; have 



(87) There can be no doubt of the efficacy of copious bleed- 
ing for the cure of this disease, where it is accompanied with 
great activity or tension in the blood vessels. In their reverse 
state, stimulants have been used with advantage. 



198 DISEASES, ACUTE AND CHRONCAL, 

we not just reasons to hope for its being equally as 
successful a remedy in the therapeutic cure, if taken in 
proper time? especially as it is now known to be a more 
powerful antispasmodic medicine, than the above, or any 
other medicines that we know, opium only excepted; and 
as powerful an attenuator and sudorific as them if not 
more so; does it not promise to be as successful in the 
latter, as it is known to be in the former? And if we add 
musk to the opium as above, after bleeding largely, and 
cold bathing may we not hope that it may prove to be 
the antidote against this singular poison, which the great 
Boerhaave (and all good men have) wished for, when he 
says, Aphoris. 1146: " Nee desperandum tamen, ob ex- 
empla jam in aliis venenis constantia, de inveniendo hujus 
51'ngularis veneni antidoto singulari." 



PECULIAR TO THE W. INDIA ISLANDS, &c. 199 



OF CHRONICAL DISEASE? 



HAVING treated on such acute diseases in the 
preceding part, as are either peculiar to, or endemial in 
the West-India islands, and such countries as are situ- 
ated within the torrid zone, and are not so frequently 
seen in most parts of Europe; I shall here speak of such 
chronical diseases as are either indigenous or endemial, 
in the same warm countries, and are unknown and never 
seen but in the hot climates, except when they are ear- 
ned by the sick into the colder countries. 

And I shall begin with the description of a disease, 
which I think I may safely say is new, and has never 
yet been described by any author, neither ancient nor 
modern, not even by any of the Arabian physicians; 
most of whom lived and practised in the hot countries 
of Persia, Syria, Arabia, and Egypt; but of late years 
is become endemial and frequent in Barbadoes, and the 
other West-India islands. 

From the best accounts that I can obtain, this malady 
has been some chance time seen in this island, near these 
thirty years, though but very seldom; and after I came there 



200 DISEASES, ACUTE AND CHRONICAL, 

in 1747, I did but see one person who had it, in the first 
four years of my residing there; and three more in the 
next three years: but within the four last years past, it 
is become so frequent, that I have seen some scores of 
patients labouring under it, yet it seems not to be in the 
least infectious or contagious. 

The patient who labours under this disease, usually 
first complains of an uneasy sensation, or slight burning 
heat about the cardia, or upper mouth of the stomach; 
which comes slowly on, and gradually increases, and 
rises up the oesophagus into the mouth, without any fever, 
or the least feverish heat, or much pain attending it; most 
commonly without any observable intemperance or irregu- 
larity in living, or without any surfeit, taking cold, or 
any sort of fever or other disorder, which it can be attri- 
buted to, preceding it, or any manifest or immediate 
cause, to which it can be ascribed. 

Soon after this burning heat, little small pustulae, or 
pimples, filled with a clear acrid lymph, no bigger than 
a pins head begin to rise; generally first on the end 
and sides of the tongue, which grdually increase in 
number, not in magnitude, and slowly spread under the 
tongue, and sometimes to the palate and roof of the 
mouth, and the inside of the lips; and soon after the thin 
skin which covers those pustulre, slips off, and the tongue 
looks red and a little inflamed, though not swelled, yet 
is almost raw like a piece of raw flesh, and is so tender 
and sore, that the patient can eat no food but what is 
soft and smooth, nor drink any thing that is vinous, spir- 
ituous, or the least pungent, without acute pain; so that 
some suffer much from the want of proper food. In some 
a ptyalisme comes on, and continues a long time, which 
is so far from being of any service, or giving any re- 
lief to the patient, that on the contrary it drains and ex- 
hausts the fluids of the body, and greatly wastes and sinks 
them. 

In this state they continue several days, or weeks, 
and sometimes for months, sometimes a little better, then 
worse again; and after a considerable time, sometimes 
longer, and sometimes shorter, the pustulse will disappear 
and the mouth grow well, without any medicines or ap- 



PECULIAR TO THE W. INDIA ISLANDS, &c. 201 

plications, or any manifest cause, and continue so for 
several days or weeks; but soon after this, the patient 
finds a burning heat in the oesophagus and stomach, attend- 
ed with ructuses and sometimes vomitings, by which a 
clear acrid lymph, or waterish phlegm, which is very hot, 
and most commonly very acid, is brought up; though 
in some few it is not so acid: this generally continues 
but a little time before a diarrhoea comes on, and contin- 
ues a longer or shorter time in different patients, and 
sometimes for a longer or shorter time in the same person, 
and in some it continues for many weeks; and in 
all it greatly wastes their flesh and strength, and sinks 
their spirits very much. The diarrhoea after continuing 
a longer or shorter time, sometimes stops without taking 
any medicines, or doing any thing to stay it, and the 
patient thinks himself better for a short time, and 
sometimes for a longer time; but in general the acrid 
humor soon returns to the mouth again, with all the 
same symptoms, but somewhat increased or aggravated; 
and after some stay there, it removes from thence to the 
stomach and bowels again; and thus a metastasis of 
the humor from the mouth to the bowels, and vice 
versa, is frequently, and sometimes suddenly made, with- 
out any manifest or perceptible cause. Some chance time, 
though but seldom, after the disease has continued a long 
time, it affects all the primse viae from the lips to the 
anus at the same time, and excoriates the last; and I have 
observed in one or two cases, where the pustulae appeared 
about the genital parts, as we sometimes find the apthze 
do, as Hippocrates observes;* and in one or two cases 
I observed it to break out like an impetigo, about the 
mouth. 

The patients are all along without any fever or feverish 
heat, and their pulse is all this time rather smaller, lower, 
slower, and more languid than it was when they were in 
full health; and their body and countenance rather paler 
and somewhat colder, especially in the extreme parts, 
than when they were well: no thirst, except what the di- 

*Hippoc. de natur. muliebr. C. 61. Epid.em. lib. 3, &c» 

c 



202 DISEASES, ACUTE AND CHRONICAL, 

arrhcea causes, when it continues long, and that generally 
moderate. The patient's skin is generally dry, all the time 
of the disease, and he perspires very little.(88) 

The frequent metastases which this acrid humor 
makes from the mouth to the stomach and bowels, and 
from those to the mouth again, greatly emaciate, weaken 
and consume the patient. For when it is in the mouth, 
both it and the tongue are so excoriated, raw, tender and 
sore, that they can take no nourishment, but such 
as is very soft, smooth and mild, and in a liquid 
form, without giving them exquisite pain: and when 
it is in the stomach, it gives a painful burning sensa- 
tion, and a frequent gulping up, or vomiting a little 
clear, acrid, acid liquor, and their food also; so that 
the stomach can retain and digest nothing but what fe 
very soft, smooth and light, and sometimes not even that. 
And when the humor falls upon the intestines, it produ- 
ces a diarrhoea with a sense of heat, and sometimes a 
griping, (though the last not often) and sometimes with 
hot stools and a tenesmus; so that most of the nutritious 
juices run off that way, which greatly wastes and sinks 
the patient. These circumstances continuing, and the, 
disease frequently changing from place to place, almost 
continually deprives the sick of their proper nourishment, 
whence a true atrophy is produced, which at the last, 
either sinks the patient, or brings on a marasmus, which 
soon ends in death. 

This is a true, and I think an exact description of this 
disease, and its symptoms, which too often seizes several 
of the inhabitants of Barbadoes, and I believe of the other 
West- India islands also, and has been too often fatal to 
several of them. 

The nature, symptoms, and appearance of this disease, 
are considerably different from those of the true aphthae t 



(88) This disease is dangerous in proportion as it is limited 
to the intestinal canal. It is rarely idiopathic among adults in 
the United States, but it frequently occurs as a fatal symp- 
tom in the last stage of dyspepsia and pulmonary con- 
sumption*. 



PECULIAR TO THE W. INDIA ISLANDS, &c. 203 

either of the ancients or moderns. The true aphthae general- 
ly are either attended with a fever, or immediately follow 
a putrid fever, an irregular intermitting fever, a dysentery, 
a diarrhoea febrilis, or some other fever: this comes on 
gradually, slowly, and almost imperceptibly, and always 
without any fever, either preceding or accompanying it. 
The aphthae are much larger pustules, and either suppu- 
rate and fill with a concocted matter and form little ul- 
cusculae, or turn black and gangrenesce: these are much 
smaller, and fill with a clear acrid lymph, or ichor, and 
then excoriate the parts; but rarely or never fill with 
matter, except here and there a chance pustule when the 
disease has continued long; but never form ulcusculae, 
nor gangrenesce. These usually seize people advanced 
in years, rarely youths, and never children: the aphthae 
most frequently seize children, rarely youths, and some- 
times people in years, but most commonly either with, 
or immediately after they had a fever: * this is never 
with a fever, but on the contrary, they generally have a 
small, low, and languid pulse, and are usually colder than 
\n health. The aphthae are but of a short duration, and is 
an acute disease, and usually either kills the patient, or 
they recover in two or three weeks time, or less; but 
this disease continues w 7 ith short intervals of being a little 
better, then worse again, for several years, before it puts 
an end to life. I am informed that it has continued for 



* The great profess. Boerhaave says, that he saw two wo- 
men with small ulcers in their mouths or lips like the aphthae 
without a fever; but he relates this as an uncommon case. 
Was it not this disease? And Ketelaex says, that he has seen 
the apthae in some without a fever. Were they not scorbutic 
ulcusculae as it was in Zealand? De Apthis, p. 26. 

And the learned baron Van Swieten says, that the aphthas 
are rarely or never seen in hot countries. But he must have 
been wrong informed, for I have frequently seen them, espe- 
cially in children, and also in several ancient people in Bar- 
badoes, which is in the torrid zone, lat. 13; though they prob- 
ably may not be so frequent there, as they may be in Zealand; 
but I never yet saw it, but with a fever, or immediately after 
a fever. 



204 DISEASES, ACUTE AND CHRONICAL, 

eight or nine years in some patients before it was fatal; 
though it has been so to some others in less then a year, 
when they had lived too freely, or did not seek for proper ' 
assistance. 

It also differs considerably, and in many respects, from 
an erysipelas, or an erysipelatoides; and also a little in 
some respects from an impetigo, though it is in some 
respects most like that, and if it was external would pro- 
bably produce scaly scabs on the skin after the pustule 
broke, as I once saw it about the mouth. 

As it is a new disease, we must give it some name; 
shall we call it an aphthoides chronica, or an impetigo pri- 
marum viarum? or what? But I will not dispute with any 
about its name, as that is only a dispute about words; 
and if any person will give it a better name, I will readi- 
ly agree with him, and thank him also. 

As this disease comes on so slowly, and increases 
gradually and almost imperceptibly, and continues with 
little or no pain, except the soreness of the mouth, and 
sometimes a little griping in the bowels, it is too often 
neglected, or trifled with, till it is far advanced; and even 
then, it is sometimes difficult to convince the patients 
that they are in any danger from it, or to prevail on them 
to take such medicines as are necessary; so that it is too 
often neglected so long, that it is not in the power of 
medicines, or art, to save their lives. 

Divers means, and various methods have been tried 
to cure this too often fatal disease, in this unlearned part 
ot the world; but as they were generally immethodical, 
and without success, I shall not mention any of them 
here. 

As I could not meet with any description, or the least 
mention of this disease, in any of the ancient Greek or 
Arabian physician's works that are come to our hands, nor 
yet in any modern author; I was obliged to get the best 
knowledge of it that I could, by carefully observing its 
symptoms, and examining what functions of life were 
either impaired, irregularly performed, or obstructed; 
and from thence endeavour to discover the nature, cause, 
and diathesis of the disease; and from thence to deduce 



PECULIAR TO THE W. INDIA ISLANDS, &c. soo- 
the intentions of cure, and form the most rational meth- 
ods of practice, to answer those intentions of cure, that 
I could by observation, inductive reasoning, and analogy; 
and again to improve that by observation and experience: 
which method I shall now communicate, and leave to 
others to improve, or find a better if they can. 

As this distemper generally comes imperceptibly on, 
and often without any apparent manifest cause, it is diffi- 
cult to discover what its true procatarctic cause is. But as 
it appears from the nature, symptoms, and diathesis of 
this disease, that whatever will diminish the strength of 
the vis vitae, and lessen the momentum of the circulating 
fluids, and at the same time diminish or obstruct the 
quantity of matter which ought to be carried off by in- 
sensible perspiration and sweat, may be the procatarctic 
cause of this disease; and these causes may be various 
and many; as too great a delicacy and natural weakness, 
or too great a relaxation of the solids; taking cold, using 
wet linen, damp sheets, or too suddenly stopping or ob- 
structing the perspiration, in such a weak relaxed con- 
stitution; too often and over freely drinking vinous or 
spirituous liquors; too great anxiety, distress, or concern 
of mind, grief, Sec. And several other things and cir- 
cumstances, which are known to relax the solids, and 
diminish the insensible perspiration at the same time. 

It appears then from the small, low, weak pulse, and 
the languid motion of the circulating fluids, and no fe- 
ver, but a coldness and dryness of the skin, especially 
of the extreme parts of the body, that there is a great 
relaxation of the solids, and consequently a great dimi- 
nution of the vis vitas and momentum of the fluids; the 
coldness, dryness, and roughness of the patient's skin, 
which usually attends this disease, shews an obstruction, 
and great want of perspiration and sweat, which in this 
warm climate generally are, and should be considerably 
great in a state of health. And the excoriation and sore- 
ness of the mouth, tongue, gula, stomach, and intestines, 
plainly demonstrate, that an acrid lymph, or sharp hu- 
mor is turned upon those parts, and produces those ef- 
. fects. From whence it appears that a relaxed state of the 



S06 DISEASES, ACUTE AND CHRONICAL, 

solids, a diminished momentum of the fluids, an obstruc- 
ted perspiration, and an acrimony of the humors arising 
from thence, and increased by the heat of the climate, 
are the immediate concurring causes of this disease. For 
it is well known, that the perspirable matter, or any oth- 
er excreted fluid being obstructed and returned upon any 
other excretory vessels, soon becomes acrid, and that it 
must still be rendered much more sharp, by retention 
and heat of the climate. 

These being the causes of this disease; we must take 
our intentions of cure from them, and they evidently ap- 
pear to be these. 

First, to cleanse the primae viae, and open the perspi- 
ratory pores, and restore a free perspiration and sweat- 
ing. 

Secondly, to correct and carry off the acrimony of the 
humors. 

Thirdly, to stay the purging, and strengthen the tone 
of the stomach and intestines, and assist nature to expel 
the humors from the internal parts, to the surface of the 
body, that they may be properly carried off their natural 
w T ay, by perspiration and sweat. 

And lastly, to strengthen the relaxed solids, and increase 
the momentum of the fluids, and thereby contribute to 
restore and continue a free perspiration, and establish 
health. 

As the humors are thus turned upon the primes viae, 
by the above-mentioned causes, and have had their afflux 
that way for a considerable time, as is commonly the case, 
the stomach and bowels are generally loaded with phlegm, 
and are foul; wherefore an emetic is first necessary, both 
to carry that off and cleanse them, and render the other 
medicines more effectual, as also to encourage perspiration: 
and here the rad. ipecacuanha pulv. is undoubtedly the 
best; and a dose of torrified rhubarb with an opiate and 
diaphoretic after it, is also a necessary. And if the di- 
arrhoea has continued some time; I have always found 
it necessary to give a small dose of the ipecacuanha 
pulv. gr. ij. vel gr. iij. about five o'clock in the evening, 
and a diaphoretic opiate after it has operated once ox 



PECULIAR TO THE W. INDIA ISLANDS, &c. 207 

twice, at going to bed, for six, eight, or ten evenings, 
as the diarrhoea has continued a longer or a shorter time 
before we begin. But if it be recent, and has not contin- 
ued so long, a less number of doses of the ipecacuanha, 
viz. five or six, may be sufficient, before the alteratives, 
and corroborating diaphoretics are given to answer the 
second and third intentions of cure: for which I have 
found the following the most successful, and therefore 
shall add the prescription, which the physician may alter 
as he sees it necessary pro re nata. 

§, sulph. antimonii precipitat. 3V. mercurii calcinat. 
subtilis. levigat. ^j. gum. guajac. pulv. extr. genti- 
anse ana 3j. camphorii 9ij. extract, thebaic, gr. x. bals. 
guajacin. q. s. misce, fi. pil. lx, de quibus capiat aeger 
tres omni nocte hora decubit. insuper bib. infusionis 
sequentis ^ij. vel §iij. 

5> rad. serpent, virg. cort. sassafrse granator. ana gj. 
cinnamoni 3ij. sal. absinth. 3j. misce, et infund. in vase 
clauso, in aq. bull, foijss. per hor. octo, et cola ft>ij. cola- 
turae adde vini crocei gj. spir. mindereri giij. misce, su- 
mat ut supra, capiat etiam gij. omni mane. 

Sometimes I have added vini antimon. gut. xx. vel 
xxx. to each dose of the infusion; and during the time 
that the patient takes these medicines, I order his body 
to be well rubbed half an hour nights and mornings, with 
a flesh-brush, or a coarse, warm, dry flannel cloth, in or- 
der to encourage a free perspiration; and use moderate ex- 
ercise on horseback, or in a chaise if weak, to increase the 
momentum of their fluids, and invigorate their solids. 
Let them also carefully avoid exposing themselves too 
suddenly to a cool air, or the damp, moist air of the night, 
or to damp linen. 

If the acid humor affects the stomach with a burning 
heat and pain, and sour belchings, as it often does in this 
case, giving magnesia alba 3j. in a draught of milk and 
water sweetened with a little sugar, in the morning, cor- 
rects the acidity, and carries it off by a gentle motion or 
two; and this may be repeated every third or fourth 
morning, as the acidity returns. 



208 DISEASES, ACUTE AND CHRONICAL, 

The corroborating diaphoretic medicines, and this 
method, should be continued constantly, till you find 
that the momentum of the circulating fluids is sufficient- 
ly invigorated, and the patient has acquired a constant, 
regular, equal warmth, without its being forced by exer- 
cise, &c. And in order to obtain this desired end, it is 
generally necessary to add a proper chalybeat, as vinum 
chalybeat, &c. and a little cortex Peruv. to the before- 
mentioned warming and corroborating medicines towards 
the latter end of the cure, and to continue the use of 
them, till they have recovered their flesh, colours and 
strength, and are perfectly recovered; otherwise they are 
subject to relapse, and the disease return again. 

But if the disease has continued a long time before 
the physician is called, as is too frequently the case here, 
so that the patient is much emaciated, and the diarrhoea 
has made frequent returns, and has continued long, and 
reduced the sick low, it will be absolutely necessary to 
repeat the small doses of the ipecacuanha, and the dia- 
phoretic opiate, several times, at any time of the disease, 
especially when the diarrhoea returns, and strong corrob- 
orating sudorifics must be constantly given after, till the 
diarrhoea is effectually stayed; and if this is not effected, 
a free perspiration cannot be restored, and continued, 
and without both, the patient cannot perfectly recover. 
And as solid medicines are often retained longer in the 
stomach and intestines, than liquids usually are, we often 
find that they will answer where the liquid will not; where- 
fore when the disease has proved very obstinate, as the 
diarrhoea too often does in this case, after giving ten or 
twelve small doses of the ipecacuanha as before, I have 
found the following composition to answer best. 

§, Electar. e scordio §j. theriac. androm. §ss. teme ja- 
pon. cort. granator. pulv. ana Sij. cinnamomi pulv. 5j. 
sulph. antimonii prtfecipit. 9ij. syr. e mecon. q. s. misce, 
fi. electar. cujus capiat ceger q. nuc. mosc. major, omni 
mane et hora decubitura, saepiusve urgente diarrhoea, su- 
perbibendo decoctionis sequent. §ij. 

5> Cort. granator. rad. serpent, virg. ana §i. cort. cin- 
nam. 3ij. misce, coq. in aq. pur. tt>ij. ad ftiss. et sub finem 



PECULIAR TO THE W. INDIA ISLANDS, &c. 209 

coctionis adde elect, e scordio §i. coq. parum et cola, co~ 
laturae adde aq. cinnamomi, tinct. terras japon. ana |i. syr. 
e mecon. gss, misce, fi. decoct, ut supra sumend. capiat 
etiam cochl. quatuor post singul. alvi deject, liquidam. 

The frictions and exercise of riding should be continu- 
ed at the same time, and the other precautions observed. 

But if notwithstanding the use of all these methods 
and medicines, the diarrhoea proves obstinate, and returns, 
as it sometimes happens; for I know no disease that is 
more obstinate, more subject to return, or more difficult 
to be cured, than this sometimes proves to be: therefore 
when this is the case, and these methods do not succeed, 
only for a time whilst they take the medicines, and the di- 
arrhoea continues to return, and the patient's skin is still 
dry, so that he cannot be brought to perspire freely as he 
should do; warm bathing, in some of the natural warm 
baths, and corroborating diaphoretics at the same time, pro- 
mise the best success. But it may be objected that warm 
bathing relaxes the solids, which are already too much re- 
laxed before by the disease; but seeing that if a free per- 
spiration cannot be restored, the distemper cannot be ef- 
fectually cured, though they may seem to be better for 
some time, yet it will often return again; though I have 
known many that have recovered perfectly without warm 
bathing, yet I have met with some who I apprehended 
could not, and found it to be so afterwards: for as I met 
with some patients whose situations were such, that they 
could not go to any of the natural warm baths; and as we 
had not any in the island of Barbadoes, I ordered an artifi- 
cial warm bath to be made of common sal. martis (called 
green copperas) sulphur vivum, and warm water, made as 
warm as the warm baths at Bath are, and added some aro- 
matics, in which the patients bathed, and were well rub- 
bed whilst in the bath; but I found that it did not answer 
in several respects, so well as the natural warm baths did, 
therefore if the patients can conveniently go to them, they 
are preferable; as they do not relax the vessels of the bo'~ 
dy in general, (though they may relax those on or near to 
the surface of it, during the time they are in the bath,) so 
much as the artificial baths do, though they are made but 

d a 






iiT. 



210 DISEASES, ACUTE AND CHRONICAL, 

equally as warm; neither are those who bathe in the natu- 
ral baths, so subject to take cold after bathing, as those who 
bathe in the artificial baths are, as I have several times ob- 
served; and it must be granted that the natural warm sul- 
phurous baths, as those of Bath, Aix la Chapelle, Barage., 
Aix in Provence, and those in Portugal; and it is very pro- 
bable that the warm baths in Jamaica, Nevis, and Caroli- 
na, if they were properly examined by fit experiments, 
would be found to be of the same nature, and probably 
equally as good as the above-mentioned baths are; all these 
natural baths, greatly exceed all the artificial warm baths 
that we can make: for whenever nature acts the chemist, 
she far exceeds the greatest artist, and the ablest chemist. 
Besides this, those who go to those natural warm baths, 
have the advantage of drinking their waters daily, during 
the time of bathing, whereby the acrid saline humors may 
be attenuated, diluted, dissolved, and at least some of them 
carried off by sweat and urine: and what is still of greater 
importance, by drinking those w 7 aters, their solids will be 
somewhat braced, and the circulation of their fluids increas- 
ed, and consequently a freer perspiration obtained, and 
continued. And though warm bathing may be objected 
to, as it relaxes the solids for a time, yet as it contributes 
to cleanse the obstructed mouths of the perspiratory pores 
and sudorific ducts, and gently relaxes the coats of those 
obstructed vessels on the surface of the body, whilst the 
heat of the bath increases the momentum of the circula- 
ting fluids, at the same time; they must by thus jointly 
acting together, more effectually remove the obstructing 
cause, and carry it out of the small obstructed vessels. 
Since relaxing the coats of those small vessels will have 
the same effect as increasing their diameters; and the mo- 
mentum of the blood being increased by the heat of the 
bath, at the same time, must render it the most effectual 
method to remove such obstructions: and nature may be 
assisted in this work, b> giving a deobstruent, diaphoretic 
draught, half an hour before the patient goes into the 
bath. I have found the following to answer this end the 
best; but it may be altered pro re nata. 



PECULIAR TO THE W. INDIA ISLANDS, &c. 211 

& Rad. serpent, virg. Sss. vel 5i. theriac. androm. 5SS. 
misce et infund. in a q- pur. bull. q. s. ut col. giss. colaturse 
adde sal. diuretic. Qi. spir. mindereri 5113. vini crocei 51J. 
syr. crocei 5'ij. misce, fi. haust. ut supra sumend. 

Also rubbing the patient's body very well, both when 
he is in, and after he conies out of the bath; and then 
going into a warm bed, and encouraging a free perspira- 
tion, and moderate sweating, by drinking warm Bath- 
water, will contribute much to the same purpose: and 
the corroborating diaphoretic medicines before advised, 
may be continued with the Bath-waters, during the in- 
tervals between the times of going into the bath, in or- 
der to brace up and strengthen the internal relaxed weak 
vessels, and increase the momentum of the fluids, and 
enable nature to cast out the humors from the internal 
parts, to the surface of the body, that they may be car- 
ried off by perspiration in their natural way. And though 
warm bathing may a little relax the vessels on and near 
to the surface of the body, yet it does not affect the larg- 
er internal vessels, which are not exposed to it, so much 
as is sometimes apprehended, as I have often observed; 
but going into the baths with too great a plethora, 
or fulness of the vessels, has undoubtedly done much 
hurt, and has brought bathing into some discredit, and 
caused it to be much less used than it was formerly. 

These remarks on bathing and its effects, especially in 
this disease, are not only plausible in theory, but I have 
found them to be true in fact; for I advised several 
patients who laboured under this disease to come 
to Bath in Somersetshire, and to drink those waters, 
but they were not permitted to bathe in the waters 
as I advised, though they drank them a considerable 
and sufficient time, and no doubt took proper medi- 
cines with them, yet they returned full as bad, and some 
of them worse than when they went; wherefore I gave 
the next patient that came to the bath, full directions 
both to drink the waters and bathe in them, though he 
was more reduced and brought lower and weaker, than 
any of the others were, before he came: he accordingly, 
drank the waters five or six v/eeks, and bathed twelve 



sag DISEASES, ACUTE AND CHRONICAL, 

times in the bath, and took the before -mentioned corrobo- 
rating diaphoretic medicines with them, after taking aa 
emetic and a dose of rhubarb, and returned to the island 
perfectly recovered, and grown strong, fat, and jolly: and 
I could mention some others who have come thither since 
with the same disease, and have used the same methods, 
and received the same advantage. As this is a new dis- 
ease, which I think has not been described before by any 
author, nor probably been seen before in this country; I 
mention this, that my brethren the physicians of Bath 
may advise such patients as labour under this disease, 
and come thither to bathe, as well as to drink the waters, 
if they think fit: sed verbum sat sapienti. 

As to the use of gargarisms in this case, they are but 
of little service, except such as are healing, when the 
mouth is very sore, as they only serve to repel the humors 
from thence to the stomach and bowels, and to which 
they are but too often translated, without any topical ap- 
plications; where they produce a diarrhoea, which is 
more difficult to be cured; when the strongest restringents 
without diaphoretics, will, at the best, only stop it for a 
little time, and it will either upon taking a little cold, 
or the least irregular accident, return again; wherefore I 
have found it necessary to advise the patients, especially 
when they did not come to Bath, and bathe, to use the 
restringent diaphoretic medicines, at least once or twice 
a day, for some time after the diarrhoea is totally stayed; 
in order to strengthen the tone of the stomach and bow- 
els, as well to invigorate the momentum of the circulating 
fluids, and restore and establish a free perspiration; for 
which purposes I have frequently, towards the latter end 
of the cure, added some chalybeat, in order to obtain 
those desired effects; for without strengthening the solids, 
and restoring a brisker circulation of the fluids, and a free 
perspiration, I cannot say that I ever yet have known any 
one perfectly recovered; though by these being restored, 
I have known many restored to health. 



PECULIAR TO THE W. INDIA ISLANDS, &c. 213 



OF THE NYCTALOPIA OR NIGHT-BLINDNESS . 



THE nyctalopia is a disease which is so frequently 
seen among the negroes in this warm part of the globe, 
land as I am informed in Africa also, that it may be just- 
ly deemed an indigenous or endemial disease in the tor- 
rid zone; though it is but very seldom seen in England, 
or in the other parts of Europe. 

The great Hippocrates, and must of the other Greek 
physicians as also the Arabians, have described this dis- 
ease very well; though their commentators and interpret- 
ers* seem to have made some mistake and confounded 
it with the hemeralopes, which probably arose from their 
having seldom or never seen it in Europe: but Galen, 
the best interpreter of some difficult passages in Hippo- 
crates, calls it NvKT^ums 9 -[ nyctalopes a night blindness; and 

* Fcesius in ceconom. Hippocrat. 

f Galenus in oeconom, Hippocr. p. 264, 



214 DISEASES, ACUTE AND CHRONICAL, 

iEtius,* who lived at Amidain Mesopotamia, now a part of 
Persia, a hotter country than Greece, probably might see 
it oftener, describes it clearly,. and the h^^jwe?, he- 
meralopea or day-blindness also, i. e. those who cannot 
see in the day time, but see well by night; likewise both 
Paulus iEginetaf and Actuariusi describe it well. Among 
the Latins Pliny § also mentions it, and the elegant Celsus 
calls it imbecillitas oculorum|| ex quo quidem interdiu 
satis, noctu nihil cernunt, they see well by day, but in the 
night nothing, or are blind.(89) 

This is a disease which is now frequently seen among 
the negroes in the West-India islands, and I have seen ma- 
ny; and an ingenious apothecary there, told me that he 
had known six, eight, ten, or twelve negroes seized with 
it in some estates, when the night came on, so that the 
other negroes who could see well were obliged to lead 
them home, though they could see well in the day-time to 
do any work, so long as the sun was above the horizon; 
but as soon as the sun was gone down, their sight began 
to grow dim; and as the darkness of the night approach- 
ed, that dimness increased, and they became perfectly 
dark and blind; and that blindness continued till the 
morning, that the sun began to rise, with which their 
sight returned also, and continued till night, when they 
became blind again; and thus they continue to be blind 
in the nights, and to see in the days, for a long time, if 
not relieved by proper remedies: sometimes some of 
them will recover their sight for several nights, and then 
lose it again, and that for several times. 

I could not observe that the variations of the weather 
had any influence or effect on this disease, either in pro- 



* iEtius Tetrabill. ii. serm. 2. cap. 46. 

f Paul. iEgineta, lib. iii. cap. 22. 

\. Actuarius meth. med. lib. ii. cap. 7. 

§ Pliny hist. nat. viii. cap. 50. 

|t Celsus, lib. vi. cap. 6. 

(89) This disease of the eyes is well known in Russia by the 
Tfame of hen-blindness. The remedies recommended for its 
cure, by the author, appear to be rational. 



PECULIAR TO THE W. INDIA ISLANDS, &c. 215 

ducing, increasing, or obating it; unless a continued 
clear, dry, hot season had some little effect on them. 

This night-blindness comes on in the evenings, after 
the sun sets, with a misty dimness, which gradually in- 
creases as the night approaches, till it becomes dark, when 
their sight becomes perfectly dark also; and without any 
pain, either in the head or eyes, or elsewhere; sometimes 
a sense of fulness in the head, and a small tinitus aurium 
attends it, at other times not, but without any virtigo or 
giddiness; no oppression or sickness at the stomach, or 
loss of appetite, neither any other complaint but the loss 
of sight; all the secretions and other functions of life seem 
to be regularly performed; neither do their eyes appear to 
be impaired or altered, the cornea and pupil appear per- 
fectly clear and well, and the iris also, which continues to 
contract a little in the day-time, and dilate as usual in the 
night, yet no vision is then performed; neither does there 
appear to be any afflux of humors to, or any signs of in- 
flammation in the eyes. 

As no external injury or impediment in the eye appears, 
its cause must be internal; and as no pain or inflammation, 
or any signs of it, attends it, it does not proceed from any 
obstruction of the sanguiferous, seriferous, or lympha- 
tic vessels; therefore it must arise from some male affec- 
tion of the retina or optic nerves, or both. And as this is 
a disease which is the most frequent within the torrid 
zone, where the reflections of the rays of light are strong 
and vigorous, and the sun being several hours every day 
almost perpendicular over them, the angle of reflection is 
very acute, and the rays of light must be strongly re- 
flected from the earth and other bodies into the eyes, con- 
sequently the sensation of them, and the vibrations of the 
retina and optic nerves must be great also; and being thus 
accustomed to such continued strong vibrations, they be- 
come weakened, and their tone greatly impaired,* so that 



^ A gentleman by riding ten miles on the sea-shore near 
noon, had his eyes so weakened by the strong reflected rays of 
light from the white sand, that he could not see so well to 
read by candle-light in the night for four or five weeks after, 



216 DISEASES, ACUTE AND CHRONICAL, 

they become insensible of the small, weak vibrations of 
the few inactive rays of light which exist in the night, and 
move with almost an infinite less force than those of the 
day, there; and when this happens to such eyes as have a 
natural imbecility in the formation of their nerves, which 
by the strong continued vibrations of the light of the day 
there, become in some degree paralytic, and insensible of 
the small, weak, vibrations of the little quantity of light 
of the night, so that they perceive no light, and remain 
blind till the sun returns in the morning, and renews the 
stronger vibrations of light again, and they see. 

This seems to be the cause of this disease, and this the 
most rational and satisfactory way of accounting for it ; 
and as it plainly and clearly accounts for all its symp- 
toms and appearances in a plain, simple manner, it ap- 
pears to be true. 

The Hetix§a\uves, hemeralopia is a disease which is very 
seldom seen ; they see pretty well in the night, but very 
little in the day, and cannot see any thing when the sun 
shines bright. It proceeds from a different and direct con- 
trary cause of the other, viz. from too great a tenderness 
and sensibility of the iris and retina, for they cannot bear 
any degree of light from the sun to fall upon their eyes, 
but are obliged to shut their eye-lids close, and so near 
closed from the light of the day when the sun does not 
shine out, as not to be able to see, as we sometimes see in 
an inflammation of the iris or retina, though no inflamma- 
tion is present here, but too great a sensibility of thos^ 
parts, so that they cannot bear the light of the day, but 
can dilate the pupil of the eye, and see very well in the 
night: I have but had an opportunity of seeing two per- 
sons who laboured under this disease.* 



as he did before and after that. And we see something like it 
in those who are snow-blind, and cannot see for some time 
after they come into a house, though it be day light. 

* When I was at the school, I saw a man who was blind in 
the day-time, and laid wagers with men who could see, to run 
races with them in dark nights ; and got his wagers, till they 
found that he could see in the night, though not in the day. 



PECULIAR TO THE W. INDIA ISLANDS, &c. 21 7 

The methods of cure which have been used in the 
nyctalopea, are various, and little has been said of the 
cure of the hemeralopea, as it is so very seldom seen. That 
recommended by Paulus iEgineta,* in the cure of the 
first, is judicious and rational, though his method of diet, 
and external applications, may be as well omitted, as 
there is no external fault in the eyes, and his external 
applications are of too gross a nature to penetrate much 
into the globe of the eye. Some from its periodical re- 
turning with the darkness of the night have supposed it 
to be of the intermitting kind, and therefore thought it 
should be treated as such; but its periodical returns, are 
solely owing to the periodical returns of the darkness of 
the night, and not to any thing in the diathesis of the 
disease; and the cortex Peruv. may be of much greater 
prejudice to the patient's constitution in some other re- 
spects, especially as we find that the methods which in- 
crease and are prejudicial in intermitting fevers, greatly 
contribute to the cure of this disease. For as Paulus iEgi- 
netaf advises, we find by experience that bleeding once, 
to a greater or less quantity, as the patient is more or less 
plethoric, and purging them twice or three times with an 
antiphlogistic attenuating cathartic, and giving the rad. 
valerian, sylv. pulv. with its volatile tincture two or three 
times a day, in the intermediate days, and for twQ or three 
days after the last purge, generally removes the disease 
and restores the patient his perfect sight. 

I have sometimes ordered their eyes to be washed with 
the following, and I think with advantage; 5> aq. rosar. 
§iss. vini antimonial. gss. misce, fi. collyr. cum quolavat. 
oculos omni nocte hora decubit. et etiam mane. And it 
is probable that the subtile particles of the antimony may 
penetrate the eye, and be of service in this case; and not 
improbably in the hemeralopea also, but I have never had 
an opportunity of trying it. 

It is said that there are a people in Siam, in the East Indies, 
and also in Africa, who are all subject to this disease of being 
blind in the day time and seeing well by night. Modern 
Univer. History, vol. vii. 

* Paulus ^Egineta, lib. iii. cap. 22, 

i Idem ibid. 

Ee 



218 DISEASES, ACUTE AND CHRONICAL, 



OF THE ELEPHANTIASIS. 



THE elephantiasis is also a disease which is either in- 
digenous or endemial to such countries as are within the 
torrid zone. 

This disease was well described by Abubeter Moha- 
med Rhazis,* who lived in Persia, about 850 years since; 
and he does not speak of it as a distemper that was new 
in his time ; therefore we may conclude, that it was well 
known in Persia, Arabia, Egypt, and the other parts of 
Africa also, as Lucretius mentioned it many ages before 
that time, as a disease of that quarter of the world. How- 
ever we are certain that the negroes first brought it from 
Africa to the West Indies, where it is now but too fjre- 
quent among them, and among the white people also, 
who are not exempted from it. 

But I cannot think with Dr. Town,f that this disease 
has any affinity to the lepra arabum, though several of the 



* Rhazis ad Manzor. Divison. lib. cap. 107. p. 418. 
[ Dr. Town on the diseases of the West Indies, p. 184. 






PECULIAR TO THE W. INDIA ISLANDS, &c. 219 

Arabian physicians, or rather their translators, have called 
the true lepra arabum by the name of elephantia; but 
Rhazis distinguishes them clearly; and how the other 
Arabians since him, and the European physicians since 
them again, have confounded their names, is difficult to 
determine. 

However it is much to be wished, that the Arabians, 
who are the first physicians that have mentioned this dis- 
ease, had more fully described its first symptoms and ap- 
pearance, and the manner of its coming on, and increasing 
to its full state, more accurately and clearly, than they or 
any since them have; which defect, I will endeavour to 
supply as well as I can, from repeated observations. 

The patient when apparently in perfect health, and 
without any preceding procatarctic cause that he knows 
of, is first seized with a cold rigor, like the fit of an 
ague, which continues one, two, or three hours, with 
acute pain in the head and back, a sickness at his sto- 
mach, and sometimes a vomiting, and great pain in one 
of the inguinal glands, sometimes in one, in others in the 
other inguinal gland, never in both, and whether it falls on 
the right or left gland the first time, it generally continues 
to fall on the same gland every fit afterwards: the rigor is 
succeeded by a very hot fever, which usually continues 
twenty, thirty, or forty-eight hours, and sometimes long- 
er; the patient is often delirious, the pain in the inguinal 
gland increases, and it swells and becomes red and hard* 
rarely or never suppurates: soon after it is thus swelled, a 
red stroke runs down the thigh from the tumefied gland, 
to the leg, almost an inch broad, and of a fresh red colour; 
the leg begins to swell, and is much inflamed, and as that 
inflammation increases, the fever abates, and at last goes 
quite off, most commonly in four or five days time; some- 
times sooner, at other times later; and in this time the 
tumefied gland subsides and comes to its natural state. 
The morbid matter being thus cast upon the leg bv this 
imperfect crisis, it continues to be much inflamed and 
swelled for several days, and then goes gradually quite 
off; and the patient seems to be perfectly well again. The 
fever makes frequent returns with all the same symptoms. 



220 DISEASES, ACUTE AND CHRONICAL, 

and in the same manner, but at no certain periodical 
times; sometimes twice, thrice, or four times in a year, 
especially in the first two or three years of the disease; 
in others, once a month or three weeks, or oftener; the 
most frequent returns that I have ever seen in any patient, 
was four times in eleven days, but then at no certain pe- 
riods; it will come sometimes at two or three weeks end, 
and the next time not till three, four, or six months after, 
but whenever it returns, the morbid matter is each time 
thrown upon the same leg, on which it chanced to fall the 
first time. (90) 

The leg most commonly remains longer swelled after 
each return of the fever, than it did in the former fit; and 
after several returns, it continues to remain swelled, after 
the inflammation is entirely gone off; and now it begins to 
appear oedematous, or as if it was anasarcous, but that the 
swelling does not retain the impression of the finger so 
much, or so long, as it will in a dropsical case. 

By these frequent returns of the fever, the leg is each 
time more and more tumefied, and the sanguiferous ves- 
sels are distended, the veins become varicose, and the 
swelling increases down from the knee to the extremities 
of the toes; the skin of that leg begins to grow rough and 
rugged; the swelling still increases, and the membrana 
cellulosa becomes very thick, hard, callous or semi-carti- 



(90) The swelling in the leg described by our author ap- 
pears to be the effect of a misplaced fever. The leg in the 
island of Barbadoes becomes the depot of this fever, as the 
liver and spleen become the depots of the bilious fevers in the 
United States. It is remarkable, that the constitution of a na- 
tive of Barbadoes, reta ; ns its disposition to throw a fever upon 
one of the lower extremities, in a foreign country. Of this the 
editor once saw an instance in a female servant who accompa- 
nied the famiiv of the late reverend and venerable Mr. Carter 
to Philadelphia about the year 1773. It yielded to the remedy 
prescribed by our author, that is the Peruvian bark. From the 
treatise upon the glandular disease of Barbadoes, by Dr. Hen- 
dy, the fevers of that island appear to have diverged, not only 
into the cells of the adipose membrane, but into most of the 
glands of the body. 



PECULIAR TO THE W. INDIA ISLANDS, &c. 221 

laginous in some places; the skin grows thicker and scaly, 
with great fissures and chops upon its surface; these 
seeming scales do not dry up and fall off, but adhere fast, 
and are daily increased and protruded by the increasing 
thickness of the membrana cellulosa; and the leg and foot 
are thus continually enlarged to an enormous bulk, when 
in size, shape, and all other external appearance it exactly 
resembles the leg of an elephant, from whence the disease 
takes its name* 

The patient continues in this condition many years, 
some have lived above twenty years, with a leg of this 
monstrous magnitude, and their appetite and digestion 
good, except in the times when the fever returned; and 
all their secretions and functions of life have been (at all 
other times) regularly performed, and they appeared as if 
in health, without being sensible of any other inconve- 
niency of life, but that of carrying along with them such a 
troublesome load of leg. This disease and bulk of leg is 
generally confined to one of them, though it is said that 
there are some very few instances, where it has affected 
both at the same time; but I never yet saw one that was so. 

I had an opportunity of seeing one of these legs, of thc 
largest size, amputated, and afterwards, at my request, 
dissected by Mr. Hickes, an ingenious surgeon in the 
navy. We found the rough, scaly skin very thick, its 
small blood vessels much enlarged; the membrana adiposa 
was exceeding thick, (though the rest of his body was 
lean and thin) in the ancle it cut full two inches thick, in 
other parts of the leg an inch and a half or more; when cut 
it looked clear, like the fat of a hog, or rather like salted 
pork; the cellulae of this membrane were greatly distend- 
ed, and filled with an oily, fat, gelatinous substance; about 
the ancle and upon the metatarsal bones it was become 
semicartilaginous, and cut with a grating noise. The coats 
of both the veins and arteries were also very considerably 
enlarged, so that such as were naturally very small 
branches of the artery, were here pretty large vessels, in- 
somuch, that when he amputated the leg, he was obliged 
to take up no fewer than twelve branches of the artery with 
his needle, though the leg was taken off above the knee. 



222 DISEASES, ACUTE AND CHRONICAL, 

and the swelling (in which the vessels were much more 
distended) extended no higher than the patella, so that the 
vessels were distended even in the thigh, where no swell- 
ing appeared. The femural artery where it was ampu- 
tated was very large, and the poplitean nerve was either 
naturally larger than usual, or its coats were rendered 
thicker by the disease. The muscles and their tendons 
were in their natural state, and the bones, even those of 
the toes, in which there was an ulcer, were all clean and 
sound. 

From whence it appears, that the morbid matter of 
this disease was solely deposited in the cellulas of the 
membrana adiposa, and was not extended or carried into 
the cellulae of that membrane which are expanded be- 
tween the mucles and their constituent fibres, but was 
deposited in the external cellulae of that membrane which 
contain the fat, after each paroxism of this peculiar fever; 
and that the cause of this monstrous leg, Which gives 
the name to this disease, is the morbid matter of a fever 
which is gradually deposited on the leg by an imperfect 
crisis of each paroxism of this peculiar fever, and is truly 
the effect of that disease; and may most properly be 
called a chronical disease, which arises from an acute one. 

I think none of the Greek physicians have given us 
any description of this disease; neither have any of the 
Arabians, except Mahomed Ebn Zacharia Rhazis,* 
who has described its last or full grown state very well, 
but not the preceding fever which produces it: he says, 
it may be cured in the beginning of the disease, but 
when it is grown inveterate, it is incurable; and the 
reason of this, will appear more fully hereafter. 

As this disease is solely produced by the fever above 
described, taking that fever off, must consequently pre* 
vent the production of it, if it be taken before the hu- 
mors art fixed in the leg. 

An inquiry into the nature and symptoms of this pre- 
ceding fever, though it is \<dvy uncertain in its intermis- 

■*Rhazis ad Monsor. Division, p. 418. 



PECULIAR TO THE W. INDIA ISLANDS, &c. 223 

sions, and irregular in its periods, yet it plainly appears 
to be something of the intermitting kind; but one which 
has not been described before by any author that I 
could find. It is well known that Hippocrates mentions 
a febris septimana, as an intermitting fever whose periodi- 
cal returns are regular, but none of any longer intermis- 
sion; besides this the manner of this fever's going off, 
by an imperfect crisis, as above, is singular and peculiar 
to itself. These considerations first induced me to try the 
following method of cure, as all the other methods used 
in these parts were generally found to be unsuccessful; 
and I found it to answer my expectations, if the disease 
was taken in proper time, before the leg was much en- 
larged, and the humors fixed there. 

When the rigor and fever has seized the patient, if I 
find one of the inguinal glands inflamed, tumefied, hard 
and painful, and the red stroke from it down the thigh 
to the leg, which are the pathognomic symptoms of this 
disease, and certainly distinguish it from all other fevers; 
though we find the patient very hot, and the fever pretty 
high, his pulse quick, full, and soft, though a little 
delirious: bleeding ought not be advised, though I have 
seen it too often too hastily practised in this case; as it 
hinders nature from critically discharging the morbid hu- 
mor upon the leg, and sometimes turns it upon the vital 
parts, and proves fatal, as I have more than once seen it: 
but in some particular plethoric constitutions, where the 
fever is very high, the pulse rapid, strong, full, and hard, 
and the patient much delirious, ten or twelve ounces of 
blood may be taken away, but not without caution and 
judgment. 

But whether you bleed or not, if the patient has great 
sickness at his stomach, with vomiting, or much reach- 
ing to vomit, it is necessary to encourage the vomiting, 
by drinking green-tea, camomile-flower-tea, or warm 
water; and sometimes to assist it by giving vini ipeca- 
cuanh. 3i. vel 51J. in them, to assist nature in her en- 
deavours; and it is probable that some of the morbid 
matter may be discharged that way; however the action 
of vomiting will assist her to cast it off upon the leg more 



224 DISEASES, ACUTE AND CHRONICAL, 

effectually and sooner; after which an anodyne diaphoretic 
bolus may be given with a little rhubard, which will give 
a motion or two after the two first have had their effect, 
and may assist to carry a little more of the humors off; 
as, §> rad. rhei pulv. 9i. pil. saponac. gr. vij. camphorii 
gr. v. sal. dieuretic. 3i. syr. e mecon. q. s. misce. fi. bolus 
ut supra sumendus, superbib. seri lactis vinos, tepide co- 
piose, et sudor, expectat. 

For it is necessary to encourage a free diaphoresis, and 
to continue it, by giving some saline draughts after, and 
diluting plentifully with small wine- whey, viburnium-tea, 
or sage-tea; both as they abate the violence of the fever by 
cooling and sweating, and assist nature to cast off the 
morbid matter both that way, and in her natural way upon 
the leg. But if the patient either from too great natural 
weakness, or by too free bleeding before we are called 
in, is too much sunk, and the pulse be too weak and low, 
though very quick, we must endeavour to assist nature to 
cast off the morbid matter, not only by the above- men- 
tioned methods, but more warming, cardiac, and volatile 
medicines must be added; and if the humors are carried 
to and affect the head, bathing their feet in a warm decoc- 
tion of viburnium (called black sage here) and vesicato- 
ries must be applied to the leg into which it vised to ikH, 
also, in order to drive the humor down thither, if possi- 
ble, or it will prove fatal. 

Though the morbid matter does most commonly fall 
upon the inguinal glands, and so into the one leg or the 
other; I have sometimes known it fall upon the arm, each 
time it came, and in more than one patient; and I once 
saw a patient where this morbid matter was cast upon the 
scalp, the ears, and the back part of the neck; and another 
wherein the matter was cast upon the lower part of the 
spina dorsi,' the os coxigis, and the lower part of the loins, 
at each time of the return of the fever, which was attended 
with all the same symptoms, as when it falls upon the 
leg; and on what part soever it falls the first time, the 
morbid matter is generally cast upon the same part, in 
every return of the fever afterwards. But these two were 
very rare, and very uncommon cases. 



PECULIAR TO THE W. INDIA ISLANDS, &c. 



oo< 



As the leg (or other part on which the morbid matter 
falls) is generally much inflamed and swelled, I usually 
order it to be fomented with a fotus of the following kind 
two or three times a day, and to cover the part with warm 
flannel after, and keep it sweating, in order to discharge 
and carry off as much of the morbid matter as we can, 
§> fol. alceae, viburnii, ana Miij. fol. salvae, flor. sambuci, 
ana Mi. sapon. venet. gss. sal. ammoniac, crud. gi. misce, 
coq. in aq. pur. ibv. deinde adde spir. sacchari, aceti com. 
ana ifess. misce. 

And after the fever-fit is entirely gone off, if the patient's 
stomach has not been sufficiently cleansed by the vomit- 
ing, as above, I usually give an emetic; and as there is a 
sufficient time before the return of another fit, and the 
following alteratives also, before I give the bark; with 
variations pro re nata. 

5> sulphur, antimon. praecipit. 9ijss. mercur. calcinat. 
levigat. 9ss. gum. guajac. pulv. 9ij. bals. Peruv. q. s. 
misce, fi. pil. xl. de quibus capiat seger quatuor omni 
nocte hora decubit. insuper bib. decoct, sequent, giij. 
?> rad. sarsaparil. 5ij. sassafr. §j. serpent, virg. gss. sal. 
dieuretic. gss. m. coq. in aq. pur. ibiij ad foij- et cola, co- 
laturas adde sp. nitri dul. |j. aq. juniperi com. |ij. misce, 
sumat ut supra, capiat etiam 3iij. omni mane. 

These medicines being taken, and the inflammation and 
swelling in the leg (or other part) gone off, I usually give 
the cortex Peruv. every three hours, till the patient has 
taken an ounce and a half, or two ounces, with elix. vitrioli 
acid. gut. xl. vel 1. in camomile-flower-tea, after each 
dose; and ten days after taking the last dose, I give ano- 
ther ounce of the bark in the same manner. And as this 
disease is very subject to return, I usually order another 
ounce of the bark to be taken in the same manner, a 
month after that, and the patient to go into the cold bath, 
or the sea, two or three times a week for several weeks 
after that again; and this method, if strictly followed, sel- 
dom fails to take the fever entirely off, and prevent its 
returning, and consequently the elephantiasis also. 

But as the great heat of this climate greatly relaxes the 
animal solids, and the people here cannot be prevailed upon 

Ff 



32.6 DISEASES, ACUTE AND CHRONICAL, 

to use cold bathing, as they do in the eastern hot coun- 
tries, and more frequently not to take their medicines re- 
gularly, this disease is very subject to return, especially 
when they have suffered it to continue for a considerable 
long time, before they entered upon this method of cure; 
and then it is usually more difficult to be effectually cured, 
than it was at the first, before such return. In this case, 
or where the patient is of a weak, lax, habit of body, I 
always advise them to repeat the alteratives once, and the 
bark, &c. also, after it, in the spring and autumn follow- 
ing, viz. in the months of April and November, and the 
cold bathing after them, as before; which generally an- 
swers the desired effect. But if they neglect this repeti- 
tion, the disease too often returns. 

This method generally succeeds when taken in time, 
before the leg be grown too large, and the disease is 
strongly fixed there, and has been so a considerable long 
time. But when this method has been neglected, or was 
not known, and the disease has continued for several years, 
so that the leg is grown very large, and its membrana 
adiposa is become very hard and callous, or almost semi- 
cartilaginous, it cannot be removed, and we can only say 
with Rhazis, that it is incurable; and nothing but amputa- 
tion can relieve them from such a load of leg. But alas! 
this does not relieve the unhappy patient from the disease, 
unless the fever be taken off also, as above; for this opera- 
tion has been often performed, but always without remov- 
ing the disease, for the fever has certainly returned, and 
the morbid matter has as constantly fallen upon the other 
leg, and produced the same effects. And whether the 
above-mentioned method and medicines, will so effectually 
succeed after such a long continuation of the disease, and 
the amputation of the leg, by eradicating its cause, and so 
prevent its coming on the other leg, or on some other part 
of the body, is what I have not had an opportunity of ex- 
periencing, so as to say it will: but as it is both very rea- 
sonable and highly probable that it may, I therefore re- 
commend it to others, that they may try it, and I wish it 
may succeed. 



PECULIAR TO THE W. INDIA ISLANDS, &c. 227 

Some have proposed keeping the end of the stump, 
after amputation, open, in order to discharge the humors 
that way, as by an issue, and thereby prevent their falling 
upon the other leg, &c. It may be tried, but I fear it will 
not succeed; because so long as the fever returns, the hu- 
mors will be renewed, and must fall somewhere, and the 
end of the stump will not be sufficient to receive and dis- 
charge them ; wherefore the method above of taking off 
the fever, is much more likely to be successful. 

Others have tried fomentations, frictions, mercurial 
ynctions, and bandages, in order to reduce those mon- 
strous swelled legs, but without success; for when it is 
become so large, and the membranes so hard, callous, and 
semicartilaginous, it cannot be reduced nor cured by art; 
quia, extra artis limites est. 



228 DISEASES, ACUTE AND CHRONICAL, 



OF THE VENA MEDINENSIS, DRACUNCULUS, OR 
GUINEA-WORM. 



THE vena medinensis, or more properly nervus medi- 
nensis, is another disease, which is peculiar to some hot 
countries, and has been well known for many ages in Ara- 
bia, Persia, and most probably in Guinea, and the south- 
ern parts of Africa. Galen is the first that mentions it, and 
calls it dracunculus,* but says that he never saw it. But 
all the Arabian physicians whose works are come to our 
hands, describe it clearly, and their method of curing it: 
Alsaharavius,f or rather his translator, calls it vena exiens: 
Mesuae, or his translator, calls it vena egrediens; J and 
Abulcasim or Albucasus, vena cruris; $ Haly Abbas, 

* Galen, de locis Affect. 6. 3. 

f Alsaharav. Oper. Tract. 28. cap. 12. p. 1R 

\ Mesuse Oper. part. 2. S. 2. cap. 7. 

§ Albucas. lib. 2. cap. 93. 



PECULIAR TO THE W. INDIA ISLANDS, &c. 2£9 

Vena saniosa;* Rhazis, calls it vena civilis, and vena 
medinesis;t and Avicena also, or his translator, calls it 
vena medinensis;{ but all the Arabian authors call it in 
their language irk medini, i. e. nervus medinensis, and 
not vena medinensis, this being a mistake in their trans- 
lators: the first from its similitude to a nerve, and Me- 
dini, of Medina, a city in Arabia, where it probably was 
first found, or taken notice of; though it is now no less 
frequent in some parts of Persia, as Dr. Kempfer ob- 
serves, and after Galen calls it Dracunculus,^ but in se- 
veral parts of Africa, and the West Indies, it is commonly 
called the Guinea- worm, because the negroes who come 
from thence, are subject to it, and frequently bring it in 
their legs to the West- India islands. 

Though this is called a nerve or vein, because it resem- 
bles the first, nevertheless it is a real worm, of a white 
colour except its head, which is blackish; its shape is 
round, long, small, and uniform like a nerve, or a piece of 
white round tape or bobbin, and not broad and flat as some 
authors say. It is found most commonly lodged in the 
legs or thighs, and sometimes in some other parts of the 
body, in, or immediately under the membrana cellulosa, 
or in the expansions of that membrane between the mus- 
cles, where it insinuates itself, and is extended to a great 
length; and is commonly from one to two feet and a half 
long. It does not cause much pain, till near the time that 
it is ready to come out, when the part where the head of 
the worm, which is always the first protruded, begins to 
swell, throb, and be inflamed and painful, like a small boiL 
generally in some part of the leg or thigh, and sometimes, 
though very seldom, higher up on the body. When this 
boil breaks, the head of the w r orm, which is of a blackish 
colour, is thrust out first, and soon after more of it comes 
out and hangs down the leg, till it is extracted in the 
manner hereafter described* 



* Haly Abbas Theor. Practic. 

f Rhazis Cont. Tr. 26. T. 2. cap. 1. p. 298. 

j Avicen. Canon. Med. 

4 Kempfer. Amenitat. Exotic. 



230 diseases; acute and chronical, 

This disease proceeds from drinking the water of stag- 
nating ponds, in hot countries, after droughts and sultry- 
hot seasons, wherein the ova or animalcula of this worm 
are contained, as in Arabia, Persia, the East and West 
Indies; and I am informed that there are some stagnating 
ponds in this island, the washing in or drinking the wa- 
ters of which is subject to generate this worm. 

In the cure of this disease, both Rhazis and Avicenna 
advise giving aloetics to hasten the protrusion and exclu- 
sion of the worms: when the little tumors, where the head 
of the worms begin to appear and swell, they hasten their 
suppuration with cataplasms, or other applications; and 
when these tumors break, the end of the worm being 
thrust out, they advise it to be tied to a piece of lead made 
in a long form, and about half a drachm weight, that the 
worm may not contract and draw itself in again; and roll 
it round that piece of lead a little every day, till it is all 
entirely extracted. The surgeons here use the same me- 
thod, only they use a little piece of silk, cotton or lint in- 
stead of the lead, about which they roll it daily an inch or 
more at a time 5 till it is all extracted, taking great care not 
to break the worm, (which caution the Arabians also give) 
for if they break it, it is exceeding difficult, and sometimes 
impossible to recover the end again; in which case an 
abscess, or rather many abscesses, will be formed, not 
only at the place of the exit of the worm, but all along the 
whole winding meatuses where the dead putrefied worm 
remains, which sometimes degenerate into bad ulcers, 
and give the surgeon much trouble, and the patient a 
great deal of pain. 

Giving aloetics, or other antihelmitic medicines, as the 
Arabians advise, to dislodge and hasten the extraction 
of the worms, is a judicious practice; but as these act 
more immediately on the primee vice, than the fleshy parts 
and surface of the body, the following coarse composition 
has been found to be much more efficacious. 

§> sulphur, viv. rad. alii ana %]. piper, nigr. gss. 
camphor. 3ij. spir. vinos, tenuis tbij. misce, et digere s. 
a. et cola, colaturae capiat reger cochl. duo bis vel ter de 



die. 



PECUUAETO THE W. IjSTOIA ISLANDS, &c. 231 

The subtile volatile pungent parts of this inelegant com- 
position so stimulates and affects these worms, that they 
generally endeavour to make their exit, and draw them- 
selves towards the surface of the body, where a small 
tumor forms under the skin, in which they collect and 
coil themselves up, and die; and the tumor being openedj 
they are easily taken out whole; and not only the worm 
which first appeared, but all the other worms of the same 
sort which are in the body, do the same; and are thus 
taken out in the same manner, where they appear. And 
when the worms are thus taken out, the places from 
whence they were taken, being not much more than skin 
deep, soon heal up with any common digestive, and no 
further uneasiness remains in the parts from whence the 
worms were taken, and the patient enjoys as good state of 
health as ever he did before. 



232 DISEASES, ACUTE AND CHRONICAL, 



OF THE LEPROSY OF THE ARABIANS. 



THE lepra Arabum is indisputably a disease which 
is peculiar to such countries as are situated within the 
torrid zone; and was known many ages since in Arabia, 
Persia, and in various parts of Africa; in which countries 
it seems to have been indigenous. Different names have 
been given to this disease by different authors, which 
has caused some mistakes and confusion among more 
modern authors, who probably had never seen it. Most 
if not all the Greek physicians, who lived after Galen, 
have mentioned it; as Aretaeus of Cappadox, Paulus of 
/Egina, and iEtius of Amida, and either call it «**P*s> 
clephantia, or & e p a v1iW/*, elephantiasis, though it is a 
very different distemper from what Rhazis, and what we 
now call an elephantiasis. i£tius,* who lived in Meso- 
potamia, most probably had frequently seen it, and de- 

#iEtius tetera biblos, lib. 13. 



PECULIAR TO THE W. INDIA ISLANDS, &c. 233 

scribes it and its symptoms very well; but it is probable 
that the other Greek writers had very seldom or never seen 
it, as they describe it less accurately than they generally 
have done other diseases, with which they were more fre* 
quently conversant. Ebn Zacariah Rhazis the oldest of 
the Arabian physicians, except Serapion, calls it lepra*' 
the leprosy, though Haly Abbas or his translator, calls 
it elephantia;f AvicennaJ gives it both these names; and 
the learned Dr. Lommius,^ has given us an elegant and 
concise description of this disease, and calls it elephantia, 
yet several other modern authors have confounded the 
symptoms of this disease, with those of the lepra gre- 
corum, though they are quite different diseases. 

All the above-mentioned authors, and several others, 
unanimously agree that this leprosy is a contagious dis- 
ease, and that it not only descends from parents to their 
children, but that it is communicated from one leprous 
person to others with whom he cohabits: and several of 
these authors advise, that all leprous persons be separated 
from the commerce and converse of the sound, as in the 
plague, and to have suitable places allotted to them to live 
in, either in an island, or somewhere near to the sea shore, 
where all communication with those who are sound, may 
be entirely cut off. This dreadful disease, was first brought 
to this and the other sugar islands by the negroes from 
Africa, and is undoubtedly a native of that quarter of the 
world and Arabia, and is not originally of this western 
part of it; neither was it ever known here, before it was 
brought hither by the negroes, among whom it is now too 
frequent here, and has made its way into several families 
of the white people also; and it is much to be feared, that 
it will spread further in this warm climate, into many 
more both white and black families, if the legislative pow- 
er do not interpose, and endeavour to prevent its spread - 

* Rhazis Division. L. 1. cap. 120. p. 422. 

f Haly Abbas Theor. L. 8. p. 97. Practic. L. 4, p. 197. 

X Avicen. Can. V. 2. L. 4. p. 133, &c. 

§ Lommii Observat. Med. p. 53* 



234 DISEASES, ACUTE AND CHRONICAL, 

ing, by some suitable, wise, and effectual laws, as we sec 
the French and Spaniards have done. (91) 

This terrible disease generally seizes the patient insen- 
sibly, gradually, and slowly, when he seems to be in per- 
fect health, without sickness, pain, or any uneasiness, nay* 
often without the patient's knowing that he ails anything, 
till some other person observes, that numerous spots be- 
gin to appear in various parts of his body; first of a yellow- 
ish brownish colour, and soon after begin to turn to a 
brownish purplish colour in white people, and to a copper 
colour in the negroes: these spots usually first appear on 
the forehead and chin, and continue gradually to increase, 
both in number and magnitude, for many weeks or months, 
without the patient's knowing that he has the disease. 
And as these spots increase, the skin on and near those 
places begins to grow unequally thicker, then hard and 
rough, with hard scales, especially on the face, arms, and 
legs, with a numbness and difficulty of moving the fingers 
and toes; these scales are not like those of the lepra gre- 
corum, nor fall off as those do. The hairs on all the parts 
of the body gradually fall off, and become thinner. The 
respiration gradually grows difficult, and the voice ob- 
scure and a little hoarse, the breath foetid and offensive, the 
lobes of the ears become thick and knotty, the cheeks 



(91) The editor has taught, in his lectures, for many years, 
that the leprosy is a misplaced fever. He was led to adopt this 
opinion by its prevailing generally in countries exposed to the 
remote causes of fever; and declining in proportion as those 
remote causes have been removed. Its peculiar and obstinate 
resistance to the power of medicine, seems to depend upon its 
heing so exclusively confined to the skin. In one of the tew ca- 
ses oi this disease, which have come under the notice of the 
editor, he has observed it to be lessened in its violence in pro- 
portion as it affected the blood vessels. He can subscribe to the 
truth of the mefficacy of mercury as a remedy for it; but he 
has great pleasure in adding that he cured a case oi it, of ten 
years standing, in the Pennsylvania hospital, in the year 1809, 
fry means of arsenic, aided by a strict vegetable diet. He has 
likewise employed small and frequent bleedings in another 
case, with advantage. The blood in this case was uniformlv sizy. 



PECULIAR TO THE W. INDIA ISLANDS, &c. 235 

large and sometimes tuberous, as also the forehead and 
eyebrows; the chin is dilated, and all these are of a livid 
reddish colour: their urine is thick and turbid, like to that 
of cattle; their dispositions of mind, sleep, and dreams, 
are disturbed, like those who are melancholy, and some 
are suddenly awaked out of their sleeps as if they were 
suffocated, which causes them to jump up. All who la- 
bour under this disease have frequent and strong disposi- 
tions to venery. Varicose veins of a blackish colour, warts 
or knotty pustules, are observed to rise about the root of 
the tongue, under the eye-lids, and behind the ears. All 
these symptoms gradually and slowly increase, and grow 
worse as the disease advances; and the body becomes 
lean and deformed, while the face, calves of the legs, and 
the feet grow tumid, and the last most commonly cold 
and torpid. Thus the disease continues to increase and 
grow worse for many years; when the pinnae of the nose 
being thick and tuberous, and its cartilage or septum is 
corroded and wasted away, or falls down, and the nose 
becomes thick and flat, so that the nostrils are in a great 
measure obstructed, and the patient's voice seems hollow 
like a ventriloqui. His lips grow thick and are reverted; 
his eyes are preternaturally round at their internal angles, 
their whites become yellowish, thick and hard, almost like 
the nails of one's fingers, by the continuance of the dis- 
ease. The hairs fall off from the eye-brows and eye-lids, 
which are grown thick, hard and callous, as also from the 
chin, and others come up in their place, but much fewer 
and smaller; the ears at last become acute, and are exten- 
uated and eaten away: the fingers and toes are greatly 
swelled, and crack with dry fissures, and are sometimes 
so puffed up, that they are, as it were, buried under the 
tumor of themselves and of the feet. The muscles are 
wasted all over the body; and the face and countenance so 
disfigured with tuberous knots, as before-mentioned, that 
it appears deformed and horrid, such as that of a satyr is 
imagined to be; or like to that of a lion; hence the Greeks 
gave this disease both the names of satyriasim, and leonti- 
asim. And now when the disease is arrived at its last stage, 
the voice is exceeding hollow, and virulent ulcers affect 



236 DISEASES, ACUTE AND CHRONICAL, 

the hands and feet, and sometimes some other parts of the. 
body; and the skin, and part of the flesh on the feet, is en- 
tirely deprived of all sensation, so that if you pierce them 
with a needle, or scald them with boiling water, or even 
apply a red-hot iron to them, they are not sensible of any 
pain. And at last the humors are all become so very acrid, 
that a small fever arises, which soon carries off the mise- 
rable patient. 

I have here described all the symptoms which attend 
this loathsome disease; not that every patient who labours 
under it has every symptom here described, but some 
have more, and others have fewer of them; though, in ge- 
neral, they have much the greatest part of them sooner or 
later; and in this miserable condition, often drag on life 
for many years before they die. O the happy climate of 
England, which is totally a stranger to this, and some 
other miserable diseases! 

From the strictest inquiry, and most accurate examina- 
tion of the symptoms and nature of this disease, as also 
from anatomical dissections, it appears that the membrana 
cellulosa is the seat of this disease, which membrane it fol- 
lows almost into every part of the body , even into the ve- 
ry bones, some parts of which it tumefies and indurates, 
and renders .useless, whilst it corrodes, consumes, and 
eats away other parts, especially the cartilages, and some- 
times the very bones, when it becomes inveterate. 

Hence it appears, that when the disease has continued 
a long time, and some parts are eaten away, and others be- 
come useless, and the humors are become so acrid as to 
corrode the bones, and almost destroy the human frame, 
no remedies whatever can possibly cure it, as Haly Ab- 
bas,* and the learned Dr. Lommius say;f Inveterascen- 
tem morbum hunc depelli remediis non posse. 

Yet several ignorant and illiterate quacks, here, have 
promised a certain cure, even at any time of the disease, 
but have as constantly failed of success; for those very pre- 
tensions and promises, which such men usually make, are 



* Haly Abbas in loco citat, 

f Lommii Obs. Med. lib. i. p. 55, 



PECULIAR TO THE W. INDIA ISLANDS, &c. 237 

sufficient proofs that they are both ignorant of the nature 
of the disease, and the power of their medicines. I grant 
that the least hopes of being delivered from so deplorable 
a distemper, is some excuse for the credulity of the peo- 
ple, and their suffering themselves to be imposed on by 
such vain, ignorant boasters. And I mention this, to pre- 
vent such impositions for the future. 

But if the disease be taken in time, viz. at the begin- 
ning, and first appearance of its symptoms, the spots 
above mentioned, &c. we have sufficient reasons to be- 
lieve it may be cured; and I have seen some instances of 
its being cured. 

Notwithstanding that the seat of the venereal disease is 
allowed to be chiefly in the expansions of the membrana 
adiposa vel cellulosa, as well as is this disease; and is 
principally cured by the use of mercury, or the different 
preparations of it; yet it is very remarkable that this dis- 
ease is so far from being either cured, or relieved by it, 
that on the contrary, it is greatly increased, and all its 
symptoms much aggravated by the use of mercurials. I 
grant that it seems to abate the distemper for a little time, 
but it soon returns with almost double force and violence 
after it: and antimony, or the best preparations of it, w 7 hich 
are of little service in the former, are found to be the most 
efficacious medicines in the cure of this disease, if proper- 
ly given, and the disease be taken in time. 

When the above-mentioned spots first appear, either of 
a yellowish, or brownish purple colour, in order to dis- 
tinguish and be certain whether they are the true spots of 
this leprosy, or they are spots of another kind, which are 
not uncommon in this climate, and look like them, but 
proceed from another cause, and are of no bad conse- 
quence; anoint the spots gently with a little ol. tartari per 
deliquium, and a little after rub it well off, and if the spots 
disappear, and return not again, they are not leprous spots; 
but if they remain, or soon return again after being thus 
anointed and rubbed, they are the true leprous spots, 
though the patient finds himself perfectly well in alt 
other respects, and may continue so for many months, 



238 DISEASES, ACUTE AN13 CHRONICAL, 

Wherefore it is necessary to attempt the cure before the 
disease gains further ground, and becomes inveterate. 

To which purpose, if the patient be of a sanguine ple- 
thoric constitution, it is adviseable to bleed, to ten, twelve, 
or fourteen ounces; after which an antimonial vomit 
should be given; and then let them enter on the following 
course of medicines, and continue it for two or three 
monhs. 

& Sulph. antimonii pnecipit. 5iij- mercurii calcinat. 
levigat. gr. xxx gum. guajac. pulv. 5iii. bals. guajacim. 
q. s. ol. sassafras gut. xx. misce, fi. pil. lxxxx. de quibus 
capiat aeg-er tres omni nocte, hora decubitura, superbib. 
gut. l. tinct. sequentis in ^iij. decoct, sequentis. 

§> Vini antimonial. §ij. tinct. aromatic. §ss. misce. fi, 
tinct. ut supra sumemh. 

$> Rad. sarsapariL fiij. cort. sassafr. *j. sal. diuretic* 
|ss. misce, coq. vase clauso in aq. pur. tt>iijss. ad ibijss. 
et cola; colaturae adde tinct. antimonii 5j. aq. juniperi c. 
§jss. sacchar. q. s. misce, fi. decoct, ut supra sumend. 
bibat etiam hujus decoct. §iij. omni mane cum gut. l. 
tinct. supra prae script. 

This method should be continued two months, or 
longer if the spots do not entirely disappear before that 
time, for it is necessary to continue them for some time 
after they are gone off. And the spots should be rubbed 
well once or twice a day, with a warm dry flannel-cloth, 
first holden a little over the fumes of burning sulphur 
mixed with a little antimony, and daily continued as long 
as the spots remain. 

If the disease does not abate, and the spots, torpor, and 
numbness decrease, it is sometimes necessary to repeat 
the antimonial vomit two or three times during this 
course, especially when the disease is hereditary, or proves 
very obstinate: and in this case it is necessary to repeat 
the whole course over again two or three months after, 
however in the next spring or autumn following, or both 
if the least symptoms then appear, as we know no disease 
that is more obstinate or more difficult to cure. And as 
the infectious miasmata of this disease, especially when it 
is hereditary, are subject to lay as it were quiet and still-, 



PECULIAR TO THE W. INDIA ISLANDS, &c. 239 

without giving the patient any uneasiness, or even without 
shewing any symptoms or remains of the disease, for a 
year, or sometimes years, and then break out and shew 
its malignity with force again; I think it is absolutely ne- 
cessary to repeat this course of medicines every spring 
and autumn, especially when it is obstinate, for two years, 
and when it is hereditary, for more years; for too much 
caution cannot be taken against so dreadful and loathsome 
a disease. Wherefore I sometimes give something of the 
following nature spring and autumn after all. 

§> Antimonii crud. subtilis. levig. gjss. tartar, solubil. 
sal. diuretic, milleped. praeparat. pulv. ana gss. zinziber. 
cond. gss. syr. e sulph. q. s. misce, fi. elect, cujus capiat 
seger q. nuc. mosc. major mane et hora decubit. insuper 
bibend. tinct. supra prescript, gut. l. in haustu decoct, 
ante prescript. 

As to the dietetic part of the cure, it is not only neces- 
sary that the patients live temperately, but there are seve- 
ral things which must be placed among the ledentia in this 
disease, from which the patient must abstain. They must 
religiously abstain from all s wines flesh, and all fat meats, 
and every thing that is oily, fat, or greasy, either in sauces 
or other ways, and that not only during the time they are 
under this course of medicines, but for many years after. 
They may eat any sort of flesh-meats at noon, that are not 
too fat, too much salted, or too high seasoned, with roots, 
greens, and plain sauces; but the more plain, simple, and 
the lighter, and more easily digested they are, the better; 
they should be also very temperate in the use of wine and 
all spirituous liquors, and strictly abstain from all kinds 
of malt liquors, for they are by no means a proper drink 
in the hot climates, as they are too viscid and glutinous 
a liquid, they require more labour and action, in order to 
digest and animalize them, than can be well used here; 
and as the heat is great, and we perspire much, and soon, 
they are carried into the blood too soon and too crude, 
before they are half digested and animalized, and often do 
much hurt, as I have often observed, and therefore men- 
tion it here. Small punch moderately acid, is a much more 
proper beverage for the hot climates: their diet alsomorn- 



240 DISEASES, ACUTE AND CHRONICAL^ 

ings and nights should be light and easily digested, and 
gently attenuating and diluting. 

These rules may seem to be too rigid and severe to 
some, but they are absolutely necessary, if the patient is 
obliged to continue in a hot climate, and yet desires to 
recover his health, and live free from this dreadful dis- 
ease. It is highly probable, that removing into a colder 
climate, may considerably contribute to their recovery; 
and re-establishing their health, especially as a hot cli- 
mate is the parent and producer of this disease. 

This method has succeeded, when the distemper has 
been taken in time, before it was too far advanced, and 
too deeply rooted in the constitution, and the whole mass 
of the fluids too much inquinated; I therefore communi- 
cate it to others, that they may either use it, or improve 
it if they can; and I wish them all success. 

I have here given several formulae or prescriptions., 
which are only suited to some constitutions and cases, 
and are only given as a general plan; and am very sen- 
sible that it will be necessary to make some alterations 
in them, as well in regard to the different constitutions, 
as to the different ages of the patients: and so it is in all 
other diseases, wherein we must vary from any rules 
which can be laid down; but the judicious physician will 
from these readily know when, and how far it is neces- 
sary to make such alterations. 

But when this disease is hereditary, and is arrived to 
its last stage, so that the whole cellular membrane is load- 
ed with the morbid matter, and the bones corroded and 
eaten away, neither this method, nor any other whatever 
yet known, can recover such a patient, nor possibly re- 
store him to health again; therefore we can only say with 
Haly Abbas and the learned and eloquent Dr. Lommius, 
" Scire tamen licet, inveterascentem morbem hunc depelli 
remediis non posse. Nam extra artis limites est." 



PECULIAR TO THE W. INDIA ISLANDS, &c. 241 



OF THE LEPROSY OF THE JOINTS. 



THERE is another species of this leprosy, which 
Haly Abbas mentions; he says, " Sunt autem elephantine 
species duae." The first is that which is described be- 
fore; " Altera et secunda, quam ex humore 

nigro, quam ex colore generatur rubeae adustionem, in 
hac specie membrorum est comestio et casus; et ab hac 
nulla sanatur quovis medela." 

I cannot find that any of the Greek physicians, nor 
yet any of the Arabians, except Haly Abbas, mention 
this kind of leprosy, unless we suppose that they made 
no distinction between this and the preceding leprosy, 
and that they speak of them as one disease; and that 
they meant this sort of leprosy, where they mention 
the falling off of the limbs, when they are treating on the 
elephantia or other leprosy. Dr. Town describes this sort 
of leprosy, but with the vulgar calls it the joint evil,* 

* Dr. Town on the West- India diseases, 

H h 



242 DISEASES, ACUTE AND CHRONICAL, 

though it has not the least appearance or nature of a 
scrophulae in it: but I am more surprised to find the 
same learned gentleman call it a cutaneous disease, when 
it eats the flesh even to the bones, and corrodes them 
also, till the fingers and toes drop off joint by joint. He 
also says that it is a disease which has not been taken no- 
tice of by any author; but if he had inquired further, he 
would have found that Haly Abbas the Persian magus, 
had described it almost 800 years before him: however 
the Dr. has described it very well, and justly observes, 
that it was first brought hither by the negroes from 
Guiney in Africa, where it now seizes many of the ne- 
groes both natives and those who are imported from Af- 
rica; and I may add several white people also, who are 
natives; whatever it might do in his time, which is not 
much above twenty years since, I cannot say. 

This sort of leprosy, when it first appears, seizes the 
patient in the same manner, and with the same symptoms, 
as the other kind of leprosy before described; so that it 
is not possible to tell for a considerable time, whether of 
them it will prove to be: for when the patient thinks 
himself perfectly well, several superficial spots of a yel- 
lowish, brownish, copper colour, with a purplish cast in 
white people, and of a dark brownish copper colour iu 
the blacks, first appear in several parts of the face, especial- 
ly about the nose, and soon after on several other parts of 
the body; at first without any uneasiness or roughness in 
the skin, or any sense of pain, and often without the person's 
knowing that they have either this or any other disease, till 
told of it by others who see them. These spots spread by slow 
degrees, and increase both in number and magnitude, till 
they cover a considerable part of the body, and yet with 
very little uneasiness or pain; and thus they remain grad- 
ually and slowly to increase for several months, and 
sometimes years, and then the fingers and toes begin to 
be numb, and gradually but slowly to swell, especially at 
their ends, and their nails are curved inwards, which 
plainly shew it to be this kind of leprosy: and thus they 
continue to grow slowly worse and worse, till their fingers 
and toes begin to ulcerate; the ulcers are very small. 



PECULIAR TO THE W. INDIA ISLANDS, Sec. 243 

never digest, nor are much inflamed, but generally look 
dry, without much foulness, matter, or fceior, and, being 
almost insensible, without much pain: these gradually 
creep on from one joint to another, and corrode the 
ligaments, tendons, nerves, and all the vessels to the very 
bones, but without much pain, all the parts being be- 
numbed and almost deprived of all sensation; and that 
joint soon drops off easily, and the ulcers creep on to the 
next joints which soon drop off in the same manner, and 
so creep on from joint to joint, till all the fingers and 
toes are corroded and quite dropt off: it then seizes the 
joints of the carpus and metatarsus; but before it can 
erode all those, it also seizes the trunk of the body, ai^d 
breaks out in little small dry ulcers, with dry scabs in 
the arms, legs, and most parts of the body; and now the 
distemper becomes infectious, if it was not so sooner. 
These small ulcers never penetrate deep into the mus- 
cular flesh of the body, but spread and extend them- 
selves on its surface, in the membrana adiposa, and dis- 
charge a little thin acrid ichor, w r hich dries up into scaly 
scabs, and emaciates the patient away, sometimes in two 
or three years time, and often is much longer before it 
puts an end to their miserable life; for there are some 
instances of patients who have dragged on a miserable 
loathsome life for ten or fifteen years or more, before 
thev died. 

The method of cure in this, must be the same as in 
the other kind of leprosy; for it is no less remarkable in 
this, than in the other, that all mercurials, however pre- 
pared (except the mercurius calcinatus^ given in small 
doses as an alterative with antimonials, as before;) do in 
this, as well as in the other kind of leprosy, greatly aggra- 
vate all the symptoms, and increase the disease: but if 
it be taken in time, at the first appearance and begin- 
ning of the disease, and treated with antimonials, in the 
same manner as in the other leprosy, we have great rea- 
son to hope for success; though I have ndt had such op- 
portunities of trying it in this, as I have had in the other. 
But when the disease is hereditary from their parents, 
or has been neglected too long, till the joints are begun 



244 DISEASES, ACUTE AND CHRONICAL, 

to fall off, and all the fluids so inquinated and infected, 
we can do no more than say with Haly Abbas, that no re- 
medies yet known, however powerful and efficacious, can 
prevail against, and cure this disease. (92) 



(92) This formidable disease is described by Dr. John 
Hunter, in his treatise upon the diseases of Jamaica. The edi- 
tor has seen one case of it in a white inhabitant of Jamaica, 
in whom it terminated fatally, under the care of the late Dr. 
Jones. 



PECULIAR TO THE W. INDIA ISLANDS, &c. 245 



OF THE YAWS 



THAT disease which the negroes in Africa, and 
we in the West- Indies, from them, call the yaws, is a 
native of, and seems to be indigenous in Africa and Ara- 
bia; and was first brought from the former by the ne- 
groes into America and its islands. (93) 

This is a distemper which has been well known for 
many ages in Africa, and some of its neighbouring coun- 
tries which are situated within the torrid zone: but I do 
not find that any cf the Greek physicians, nor yet any 
of the Arabians, do mention it, except Haly Abbas the 



(93) The editor can add nothing to the author's remarks upon 
the yaws from his own experience. He considers all the va- 
rieties of the impetigines of Dr. Cullen, as different forms of 
one disease, and that the different issue of the same remedies, 
when given to remove them, depends upon their different seats, 
duration, force and greater or less concentration in the externa] 
p-^rts of the body. 



246 DISEASES, ACUTE AND CHRONICAL, 

Persian magus, who I think has described it in his the- 
oria, cap. 16. lib. 8. and calls it the lepra. He briefly 
describes it thus; Lepra albedo est quae in exterioribus 
fit cutis: et aliquando in quibusdatn sine aliis est mem- 
bris: nonnunquam verb in toto fit corpore interdum ut 

totius fit corporis color albus. Quae in membro est, si 

ex mala fit frigida complexione, haec sunt signa; quum 
membrumin quo est, album estcolore, itidemque ejus 
pili; et si cutis phlebotomo vel certe acu pungitur, san- 
guis ab eonon egreditur, sed humiditas alba. 

From this short description of the disease, and from 
its being only in some parts or members of the body, 
and sometimes all over it, on the skin, and its white co- 
lour, and particularly the hairs turning white, and upon 
opening the little tumors, only a white humor coming out; 
I think he meant this disease which we now call the 
yaws, an African name, and not the lepra Arabum, of 
which he treats in the preceding chapter, and with the 
Greek and some of the Arabian physicians calls that ele- 
phantia, but he calls this lepra; and whether this disease 
is not the same with the leprosy of the Jews, will admit 
of some dispute, though it is most probable that it is; 
but as the description which Moses their legislator has 
given us of their leprosy,* is so very short and unde- 
scriptive, it is difficult to determine; though it is more 
reasonable to suppose that it was this disease, than the 
lepra Arabum, and if so, it is a disease of great anti- 
quity: neither can we collect any thing from Moses's 
method of curing it, that can be any way useful to us 
now in curing it; for if the leprous person did receive 
any benefit from the method which Moses prescribes, 
and has left us, it must have arisen from a miraculous or 
supernatural power, and not from his being sprinkled 
with the blood of a sparrow, or any other bird, nor from 
any thing else that the priest did to the leper; though he 
was sure of being a considerable gainer by the cure. 

We are credibly told, that the yaws seldom fail to 
attack the negroes in Africa, at one time or other in their 

* Leviticus, chap. xiii. 



PECULIAR TO THE W. INDIA ISLANDS, &c. 247 

life-time, but most frequently the children and young 
people; and that they very rarely or never have it a se- 
cond time, if they have been perfectly cured the first 
time, either in their own native country by their negro 
doctors, or after they arrived here; for the negroes have 
by long observation and experience, found out a method 
of curing this disease with the caustic juices of certain 
escarotic plants externally applied, and giving the juice 
or decoctions of others internally, which they keep as a 
secret from the white people, but preserve among them- 
selves by tradition; with which they sometimes perform 
notable cures, both in this, and some other diseases. 

This disease generally makes its first appearance with- 
out any previous sickness or pain, and when die patient 
thinks himself perfectly well, in very small pimples no 
bigger than the head of a small pin, and are smooth and 
level with the skin; these daily increase and become pro- 
tuberant pustules; soon after the cuticle turns whitish, 
cracks, and rubs off, and a very small quantity of serum 
or clear ichor exudes out and dries, and becomes white, 
but neither pus nor any quantity of ichor is found in the 
tumor, but a pretty thick, white slough appears, and un- 
der that a red fungous flesh thrusts itself out of the skin, 
which gradually increases to different magnitudes, some 
not so large as the smallest wood- strawberry, some larger; 
others exceeding the size of the largest mulberry, which 
last they very much resemble, being red, and composed 
of little round knobs as they are: they appear indiffer- 
ently on all the parts of the body, but most frequently, 
and generally are the largest, about the groin, private 
parts, anus, under the arms, and in the face: and it is re- 
markable, that in general when the yaws are very large, 
they are fewer in number; and e contra, when they are 
more numerous, they are generally smaller in size. And 
as the yaws are thus increasing and coming to their 
height, the black hairs which grow out of the places 
where the yaws are, gradually turn to be perfectly white, 
like the hair of an old man; and the ichor which oozes 
out of the yaws, drying upon the skin, makes it appear of 
a whitish colour, and renders the patient a disagreeable 



248 DISEASES, ACUTE AND CHRONICAL, 

loathsome sight: and now the disease is become very in- 
fectious to those who handle or co-habit with them. 

All this time the patient neither loses his appetite, 
flesh, nor strength, and otherwise seems to be in good 
health; being free from any pain, or any uneasiness but 
what the disagreeable nastiness of the sores, and a little 
soreness occasions, for they are not painful unless they 
are roughly touched and rubbed. 

The time from their first appearance in the before- 
mentioned small pimples, to their full height or growth, 
is very different in different constitutions, as they are 
stronger or weaker, and according to the negroes being 
well fed, or the contrary; for when the negro is strong, 
lusty, and of a plethoric habit, and is well fed, the yaws 
will often arrive at their full growth, and be as large as a 
mulberry in a month's time from their first appearance; 
but when the negro is weak, low in flesh, and poorly 
fed, the yaws will be small, and often no larger than a 
strawberry at the end of three months. 

This disease is known to be infectious, but there is al- 
so a peculiar aptitude in some constitutions to receive it 
more readily, than in others, and probably in the same 
person to receive the infection more readily at one time, 
than at another time; as is also observed in the small-pox. 

This is a description of the true natural appearance 
of the disease, when it is left entirely to nature, and is 
neither retarded nor hastened by medicines, nor altered 
by external applications; and it will continue in this state 
a long time, without any material alteration, if let alone; 
and what would be the consequence, if it was left to 
continue without any medical applications, is uncertain, 
as I have never yet seen one so left without some at- 
tempts to cure it; but it is most probable that the fun- 
gus's in the yaws, would in time become phagedenic ul- 
cers, which would corrode and eat away the flesh even 
to the bones, and then produce nodes, exostoses, and ca- 
ries in them, and at last totally consume and destroy 
them also, as we see it does when the disease is wrong 
treated, and the cure attempted without success. For when 
this is the case, and the patient has taken a considerable 



PECULIAR TO THE W. INDIA ISLANDS, &c. 249 

quantity of mercury, or has been salivated, especially 
if by unction, too soon in the disease, before the morbid 
matter was sufficiently cast out to the surface of the 
body, or has been repelled into it by that or any other 
means; though the skin has been by such methods suf- 
ficiently cleared; yet the distemper not being thereby ef- 
fectually eradicated and cured, it will return again, and 
then becomes exceeding difficult to cure; and if it has 
made several of those returns, and has been repelled, and 
has at last broke out in malignant ulcers, and corroded 
the bones, it is too often incurable. But if the disease be 
judiciously treated at the first, it seldom or never proves 
dangerous, and very rarely difficult to cure. 

There is another vile custom which I must take no- 
tice of, which the surgeons of the Guinea ships generally 
practise; that is, upon the first appearance of the yaws, 
during the voyage from Guinea, they apply some strong 
repellents to them; such as the juice of roasted limes 
mixed with the rust of iron, and sulphur or gunpowder; 
by which they repel the morbid matter into the blood, 
where its acrimony is increased, though they there- 
by render their skins clean for a short time, and then rub 
them with palm oil, which makes them soft and look 
well, when they are imposed upon the planters for sound, 
healthful negroes; but in a few days or wrecks after they 
have purchased them, the virulency of the morbid mat- 
ter being increased by the retention and heat of the body, 
the yaws break out again much w r orse than ever, and are 
then very difficult to cure, or sometimes incurable. 

As this disease proceeds from a peculiar kind of infec- 
tious miasmata, which is first generated in, and is indi- 
genous to the hot climate of Africa; which nature, when 
she acts in the most salutiferous manner, always casts 
out on the surface of the body, when not hindered by 
injudicious or male practice; it consequently follows that 
the true intentions of cure, are, first, to assist nature to 
«xpel all the morbid matter to the surface of the body, 
that as much of it as possibly can, may be discharged 
that way: and, secondly, to correct the remaining part, 
and destroy such part of it as is not discharged, but re-. 



250 DISEASES, ACUTE AND CHRONICAL, 

mains lodged in those funguses and ulcers, together 
with them, by the use of proper eschar otics. 

Wherefore, as soon as the above-mentioned pimples 
begin to appear, let the negro be confined in a house or 
separate room from the rest of the negroes; or if you are 
not certain whether it be the yaws, or a sort of itch, 
which the negroes call in their language crocrow, as 
they much resemble each other at their first appearance, 
though they 'differ greatly soon after; shut the negro up 
in a room seven days, and look on him again as the Jews 
were commanded to do with their lepers, Levit. ch. xiii. 
in which time, one may most commonly be certain 
whether it be the yaws, or not; and if it be, it will be ne- 
cessary to give somethingof the following nature, in 
order to assist nature to hasten the expulsion of the 
morbid matter and bring the yaws to their full growth. 

§> iEthiop. mineral. *jss. antimon. crud. pulv. |j. 
theriac. androm. |j. camphorii pulv. 3J. syr. zinziber. 
q. s. misce, fi. elect, cujus capiat seger q. n. mosc. ma- 
jor. mane et hora decubitura, superbibend. vini anti- 
monial. gut. xl. in haustu seri lactis vel there et contin. 
donee tumores (the yaws diet.) admaturitat. perveniunt. 

It may be certainly known that the yaws are come to 
their full height, by their being at a stand, and neither 
increasing in their number nor magnitude: and when 
you see that they are at a stand, it is a proper time to 
begin to give mercurials to raise a ptyali^me; which is 
much better done by giving calomel daily than by unc- 
tion, in this disease, lest the latter should carry the mor- 
bid matter from the skin into the mass of the blood again; 
neither is it prudent to apply any mercurial unguents to 
the yaws, for the same reasons: the best method is to give 
calomel gr. v. oryj. twice a day till a moderate salivation 
is raised, and the patient spits a pint and a half every 
twenty -four hours, and never raise it higher, for few pa- 
tients in tliis hot climate, can bear a ptvasme to be raised 
so high without danger of sinking under it, or bringing 
some other bad symptoms on. By the time the salivation 
is raised to near a pint and a half, the yaws are generally 
all covered over with dry scaly scabs, which then begin 



PECULIAR TO THE W. INDIA ISLANDS, he. 251 

to fall off daily in white scales or scabs, and usually in ten 
or twelve days time more leave the skin, smooth, soft, 
and clean. And as soon as the scabs are fallen off, and 
the skin begins to be clean, cease to give any more mer- 
cury, and let the salivation go off gradually of its own 
accord; or if it continues too long, give a dose of rhu- 
barb, or some other suitable gentle cathartic. 

It frequently happens that after the yaws are in general 
gone off and healed, and the skin is become soft and clean, 
that one, or more large jaws still remain rising high, and 
are red, knotted, and moist, discharging a little ichor ; 
this is usually called the master- yaw, from its being bigger 
than any of the rest: some have been so imprudent as to 
continue, or repeat the salivation to carry it or them off, 
to the prejudice of the patient; when in reality nothing 
more is necessarv, than totally to destroy that yaw, or 
those yaws so remaining, and all their contained fungous 
flesh, with gentle escharotics; and then to incarn and cica- 
trize the place with any common digestive and desiccative. 

Some use the lapis infernalis, others a solution of mer- 
cur. sublimat. corrosiv. 5j. in spir. vini rect. sj. and 
gently touch the remaining yaws with a feather dipped in 
this, twice a day, till they are all consumed: others use 
blue vitriol, or a mixture of inercur. corrosiv. rubr. 5j. 
alum. ust. pulv. 5ss. m. This last is the gentlest, and 
safest, and at the same time full as effectual, and therefore 
is much the best. 

During the use of these escharotics, it is necessary that 
the patient take something of the following nature, in order 
to expel any remaining morbid matter, as well as to pre- 
vent any of it being repelled into the blood by those topi- 
cal applications, as also to correct the acrimony of the 
humors, and sweeten the blood, and to restore the pa- 
tient's perfect health. 

5> Ethiop. mineral. §jss. antimon. crud. pulv. Jjj. the- 
riac. androm. §^s. gum. guaiaci pulv. §iij. syr. commun. 
q. s. misce, ft. electar. capiat <eger q. nuc. mosc. major, 
mane nocteq; insuperbibend. vini antimonial. gut, xl. vel. 
1. in haustu decoct, rad. sarsaparil. etlign. sassafrae. 



252 DISEASES, ACUTE AND CHRONICAL, 

These methods generally succeed, even in the most 
numerous and worst kind of yaws, provided they have 
not been tampered with, and the morbid matter frequent- 
ly repelled, before, or other ways wrong treated. But if 
after giving the first medicines, the yaws are not nume- 
rous, nor of a bad kind, and by their coming to maturity 
soon, it appears that the morbid humors are effectually 
expelled; giving these following medicines, and using the 
last escharotic powder as above, most commonly effec- 
tually cures them without a salivation. 

& sulph. antimon. praecipit. 5ij. mercur. calcinat. levig. 
gr. xxiv. gum. guaiac. pulv. 5ij. camphor. 3ss. bals. gua- 
iacin. q. s. misce, fi. pil. lxx. de quibus capiat tres omni 
nocte hora decubit. superbib. vini antimonial. gut. xl. in 
haustu decoct, rad. sarsaparil. et ligni sassafrse. 

It sometimes happens, that after the patient is cured as 
before, and all the yaws are entirely gone; and the skin in 
every part of the body, except the soles of the feet, is 
perfectly soft, smooth, and sound, that tumors or little 
hard swellings will remain on them, which are painful, 
and so very sore, that they can neither stand up nor walk, 
nor even bear them to be touched without great pain. 
This proceeds from yaw r s rising on the soles of their feet, 
and the skin there being very hard and thick, from their 
going bare-foot, so that the yaws cannot push through so 
thick and callous a skin. This is easily remedied by bathing 
their feet in warm water, and paring off the callous skin, 
and the yaws will appear, and push themselves out, when 
they mixy be soon destroyed by the above escharotic pow- 
der, and the place cured as in the master-yaw. 

But the worst circumstances, attending this disease, 
proceed from a wrong method of treating it; either by the 
use of strong repelling applications, or by too hastily giv- 
ing mercurials, and bringing on a salivation, before nature 
has sufficiently expelled the morbid matter to the surface 
of the body, as that is the salutiferous way she takes, and 
points out to us to follow, when she is not hindered by 
wrong methods and medicines, which return the morbid 
matter into the blood again, when she has cast it out; 
when it falls upon some other excretory passages, by 



PECULIAR TO THE AV. INDIA ISLANDS, &c. 253 

which it never can be carried off, but is cast upon various 
parts of the body, where it produces the most malignant 
kind of phagedenic ulcers, which when they can be come 
at, are either exceeding difficult to cure, or are sometimes 
incurable. Or if it falls upon the bones, and brings on 
gnawing pains in the limbs, with violent nocturnal pains, 
like those which attend the venereal disease, and at last 
produces nodes, exostoses, and caries in the bones, which 
in time eats them away, and the patient after continuing a 
longtime, sometimes years, in this miserable condition, at 
last dies torpid. This is a most deplorable case! But if 
it be taken, when they have only the external ulcers, and 
before the pains in the bones, with nodes, exostoses, and 
caries come on and seize them, it may sometimes be cured 
by the following method, which has sometimes succeed- 
ed when a salivation has failed. A salivation may be 
tried in some cases; but if it does not bring the ulcers to 
digest and heal, proceed no farther, but give the following: 

§> Sulph. antimon. prsecipit. syss. mercurii calcinat. 
levigat. 3ss. gum. guaiac. pulv. 3iij. bals. guaiacin. q. s. 
camphorii pulv. 9ij. misce, fi. pil. lxxx. de quibus capiat 
aeger tres omni nocte, hora decubitura, insuperbibendo 
decoctionis sequentis %v. 

§> Rad. sarsaparil. ^iij. cort. sassafras §j. sal. nitri ^ss. 
misce, coq. inaq. pur. ibiij. ad Ibij- et cola, colaturas addc 
aq. juniperi comp. §iss. sacchar. alb. q. s. misce, fi. decoc. 
ut supra sumenda. 

§> Vini antimonial. 5J. tinct. aromatic. 3ij. misce, ca- 
piat gut l. omni mane, et hora quarta postmerid. in §v. 
decoct, supra prescript. 

And the ulcers may be dressed with this: 

JJ> Ung. basilic, flav. 5J. mercurii corrosiv. rub. levigat, 
31. alum, usti pulv. 3ss. misce, fi. bals. digest. 

And when the ulcers are clean, and begin to incarn, and 
tend to cicatrize, they may be dressed with this, till they 
are perfectly healed, and well. 

g, Empl. commun. cum gum. e minio una 5ss. mer^ 
curii corrosiv. rubr. $ij. alum. ust. pulv. 5ss. misce, fi. 
empl. 



254 DISEASES, ACUTE AND CHRONICAL, 

But when the bones are affected with nodes, and are be- 
come carious, and are in part eaten away; which most 
commonly happens to such bones as are of the most spun- 
gy nature, as are those of the metacarpus and fingers, and 
metatarsus and the toes, and the spine, with the epiphases 
of the other bones, the case is deplorable and incurable; 
nor will amputation avail even when it is in the hands, 
feet, or in such parts where that operation can be perform- 
ed; because the humor will soon fall upon some other 
parts, and produce the same effects, 



PECULIAR TO THE W. INDIA ISLANDS, &c. 255 



OF THE IMPETIGO OR RING-WORM 



THE impetigo is a cutaneous disease, which was 
well known to the ancient Greek and Arabian physicians, 
and is more or less frequent still in most other nations; 
but it is usually so mild and so easily cured in the colder 
northern countries, that it may be thought unnecessary to 
say any thing of it here. 

But it is so frequent, and so much worse, and so very 
troublesome and disagreeable as well as painful a disease, 
in the West India islands, and in that part of the continent 
of America, which is situated in, or near the torrid zone, 
that it may not only be said to be indigenous to them, but 
is often difficult to be cured. 

We are told by some of the first voyagers into this part 
of the world, that the original natives of these islands were 
then and still are so subject to a cutaneous disease, which 
is either this, or one which very much resembles it, which 
they call m their language a cowrap; that they have a tra- 
dition among themselves, that one of the seven first peo- 



256 DISEASES, ACUTE AND CHRONICAL, 

pic that were created when the world was first made, (fgr 
so many they say were at first created) was a cowrap. 

From this tradition we may however conclude that it is 
a disease, at least among them, almost as ancient as the 
race of mankind. Though we do not find that they had 
any of the before described diseases, which are indigenous 
to Africa, and have been imported with the African ne- 
groes from thence, to these western parts of the world; 
though these parts are as warm as Africa is. 

This disease first appears, without any previous sickness 
or pain in any part of the body, in some in one part, in 
others in another part, first in many small pustule or pim- 
ples, clustering together, most commonly in or near to a 
circular form, the bigness of a sixpence or shilling, of a 
reddish colour, and contain a small quantity of clear, acrid., 
saline lymph; but they soon spread, sometimes to be as 
large as the breadth of the hand, or broader, and itch most 
intolerably, especially upon the persons putting off his 
clothes at night, often to such a degree that human reso- 
lution is not able to restrain their hands from scratching; 
and that or rubbing them briskly, breaks the small pim- 
ples, and the acrid lymph oozes out, and causes a heat 
and smarting, and then it dries upon the skin, and forms 
whitish scales or scabs, which upon rubbing or scratching 
fall off again, and are daily renewed in the same manner, 
with the same symptoms of itching, &c. Thus they in- 
crease and spread to various parts of the body; and some- 
times they will leave one part of the body and remove to 
another part, without any remedies being applied. And in 
this state the disease will continue for many years, and 
probably would remain during the patient's life, if not 
removed by proper remedies. 

This is truly a cutaneous disease, and is thought by 
many to be contagious, and probably it may be so in its 
most virulent state; and whether it arises from small ani- 
malcule, like or somewhat different from the handworm, 
which is said to cause the itch, or it arises from the heat of 
the climate which so exalts and semivolatilizes the salts 
and oily particles of the animal fluids, as to change them 
from their soft bland semiammoniacal state, to a semivola- 
tile, acrid nature, which obstruct the sudorific ducts and 



PECULIAR TO THE AV. INDIA ISLANDS, he. 257 

perspiratory pores of the skin, where being retained, they 
are, by the heat of the body and the climate, still rendered 
more acrid and corroding, and so stimulate the obstruc- 
ted ducts and pores, as to produce those small pimples 
and the almost intolerable itching, and those being broken 
and torn by scratching, the acrid lymph oozes out and 
forms the scaly scabs; and this being daily repeated 
increases the acrimony of the humors, and the spreading 
of the disease to other parts of the body. And when the 
disease is suffered to continue a long time, as it is some- 
times for years, the lymph discharged becomes so very 
acrid that it corrodes the parts affected deeper, and ex- 
pands them larger, and at last degenerates sometimes in- 
to a herpes exedens. For this is only a more virulent 
and malignant degree of the impetigo. 

This being sufficient to produce this disease, without 
supposing any animalculas, it is not necessary to multi- 
ply causes, at least till such are discovered by micro- 
scopical observation; since nature is observed not to mul- 
tiply them where one is sufficient, and the remark made 
on the acrimony of the sweat, &c. before, is sufficient 
to confirm this. Wherefore the intentions of cure are to 
attenuate, break, and dissolve those viscid, saline, acrid 
molecular which are detained in, and obstruct those su- 
dorific ducts and perspiratory pores, in the parts affected, 
so that they and the obstructed fluids may be regularly 
exhaled and carried off. 

Now it is well known, that of all the medicines, wheth- 
er vegetable, animal, or mineral substances, that we are 
yet acquainted with, mercury is a body which is the most 
peculiarly adapted and fitted to answer these intentions 
of cure (whether the disease proceeds from these causes, 
or from the supposed animalcules) by its great gravity 
and easy divisibility into the minutest spherical particles; 
and long experience has also confirmed this. 

It may be thought by some persons, that some evacua- 
tions, as bleeding and purging, may be necessary, before 
we either give mercury internally, or use it externally; 
but unless a plethora indicate them, they are neither of 
any service in this, nor in some other cutaneous diseases;. 

k k 



258 DISEASES, ACUTE AND CHRONICAL, 

and purging may divert the mercurials from the skin 4 
where they are intended to act, towards the intestines af. 
terwards, and so do hurt. 

If the disease is recent, and has neither continued long, 
nor spread much, nor the humors become very acrid, 
it is most commonly very easily cured, even with a little 
sulphur either mixed with a little unguent, simplex, 
or with a little diapalma made into a plaster and ap- 
plied to the part affected; or if that be washed with 
a lotion made with rad. hellebori albi and a little 
vitrioli albi infused in water, and a few doses of lac- 
tis sulphuris taken inwardly, at the time of using them. 
But if the disease has been neglected, and has continued 
a long time, so that it is become inveterate, and the 
lymph or serum which it discharges is become very acrid 
and corroding, or where it is degenerated into a herpes 
exedens, it is difficult to be cured; and applying any un- 
guents, lotions, or any repelling medicines topically, with- 
out giving proper internal medicines at the same time, 
may be, nay, have been attended with bad consequences; 
for some who have injudiciously made use of such re- 
pelling applications, have turned that acrid humor upon 
the bowels, or the lungs, or on the vital parts, which 
have produced very bad consequences. 

Wherefore though the slight easy things above-mention- 
ed may cure it when it is moderate and recent, in some 
constitutions; yet when it has continued a long time, 
and the humor is become very acrid, and the constitu- 
tion bad, more powerful and active remedies are required: 
and I have found something of the following kind to be 
the most successful. 

J£> mercurii calcinat. subtilis. levigat. $i. sulphur, an- 
timon. praecipitat. ^iv. vel. v. gum. guaiac. pulv. 3j. 
bals. guaiacin. q. s. misce, fi. pil. xl. de quibus capiat 
ceger duas omni nocte hora decubitura. 

§> vini antimonial. gi. tinct, aromatic. §ss. m. capiat, 
gut. lx, omni mane in haustu infusionis rad. sarsaparillre. 

Where the constitution of the patient is pretty strong 
and the disease inveterate, he may take the same after 
the pills at night also; and after he has taken them sev- 



PECULIAR TO THE W. INDIA ISLANDS, &c. 259 

en or eight days, he may begin to anoint the parts af- 
fected with a little of the following every other night, 
till he has used it four or five times, and continue the 
use of the above pills and drops at the same time: and 
if any appearance of the spots remain, or return, may 
just touch them with a very little of the ointment again, 
till they are perfectly well. And if these pills and drops 
move the belly more than once or twice (at most) a day, 
I usually give extract, thebaic, gr. ss. with each dos^-of 
the pills, or so much as may be found necessary to 
stop the purging; in order that they may be carried into 
the circulating fluids, and have their proper effect upon 
them, and correct and alter the acrid humors. 

It is well known that secrets and nostrums have been 
greatly extolled and quacked upon the public, as infal- 
lible remedies for this disease; as the terra macke-machee 
among the Spaniards; an infusion of the radix hellebori 
albi, with a little alkaline salt in water, and a little milk 
added to disguise it, by the French; and several more 
have been strongly recommended by others, but they 
all in general prove ineffectual, except in a chance case 
where the disease is moderate and recent. 

However I must for the good of the public, at least 
in these parts, recommend the use of the flowers of a 
shrub, which is frequently found growing in many parts 
of this island, and has been found by repeated experience, 
to be much more effectual in the cure of this very trouble- 
some though seldom dangerous disorder, than any of the 
above-mentioned nostrums; and is said, by some persons, 
to have succeeded when the mercurials in various forms 
have failed, for which reason I shall describe this shrub 
here below,* that it may be more publicly known, and 

* Sir Hans Sloane has described this shrub in his nat. his- 
tory of Jamaica, and calls it, juglandis folio, fruticosa, silo- 
quosa, foliis pinnatis, costa media membranulis utrinque ex- 
tantibus alata, siliqua quadrangula alata: and is here vulgarly 
called the French guava bush; though it is nothing of the na- 
ture of a guava, nor any similitude to it, except its leaf, which 
much more resembles that leaf, than it does the walnuts 



260 DISEASES, ACUTE AND CHRONICAL, 

brought into more frequent use: they usually rub the 
parts affected with the impetigo, with the whole flower, 
or with the flowers reduced into a fine pulp in a marble 
mortar, very well for two or three nights, and again af- 
terwards if any spots or roughness remain or return, 
and it seldom or never fails to remove and effectually cure 
this troublesome and very uneasy disease; especially if 
the above pills and drops are taken at the same time 
though the disease be inveterate and obstinate. 



This shrub is an annual shrub, and usually rises to the 
height of four, five, or six feet high; and is of the class of 
the heptandria monogynea of Linnaeus: it has many small 
woody branches, its leaves stand on short stems opposite to 
each other, and are shaped like the leaves of the guava-bush; 
(malo punicas affinis pomifera of Sir Hans Sloane) the flowers 
are many, and stand on the ends of the branches, near to each 
other, which seem to form one oblong large flower, of an 
orange-yellowish colour, and an uncommon shape (to which I 
think the botanists have not given a name) which afterwards 
open and are a little more yellow: the perianthum consists of 
one large orange-coloured petol, and five more on the side 
next the stem which are smaller, and of a bright yellow colour, 
and seem to make a part of the corola: the corola consists 
of five petals within the perianthum, of a bright yellow colour 
when open, and oi an ovato-lanceolate figure: the stamina are 
seven, two larger shaped like the seeds of the funiculi dulcis, 
but a little larger, a third slenderer and somewhat longer, and 
four small ones at the bottom of the calyx. The pistil is muci} 
longer than the stamina, and is curvated downwards: the ger- 
men is long and oi a square figure, the style something shorten 
and the stigma small, consisting of one small aperture. 

The fruit is the pistil enlarged into the form of a long pod., 
lour, five, or six inches long, with a wing running on each 
side of the pod, from one end to the other, which gives it 
a square figure, and is first green but when ripe of a brown 
blackish colour, and contains a great number of small flattish 
cordated seeds, of a dark brown colour, \v r ith semi-valves 
between each. 

And as neither the name which is vulgarly given it here, 
nor yet that given it by Sir Hans Sloane, are proper or suitable, 
shall we call it AHfaym, Antileichen, as it expresses its medi- 
cinal virtues? 



INDEX. 



A 

Page 
ANIMAL Fluids rendered acrid by the heat of the climate, 8 
Air in Barbadoes, description of, 9 

Antiphlogistics, the most powerful, 28 

Aphthae in children, - - - - - - -17 

their method of cure, - 19,20,63 

Aphthoides Chronica, a new disease, its symptoms described, 199 
— — — - — its method of cure, - 206 

Angina Inflammatoria, its method of cure, - - 26,27 

B 

Barbadoes, a short description of, its air, water, and situ- 
ation, - -------5, 6 

Blood less sizy there in inflammatory diseases, than in colder 
countries, - - 15, 16 

Bark, Peruvian, its bad effects in remitting fevers, - 20 

in intermitting fevers with obstructions in the viscera, 

causes irremoveable obstructions, - - 20, 21 



Climate, hot, in Barbadoes its effects, - - - 6, 10 
Children clothed too warm when young, - - - 10 
Catarrhous fever frequent, - - 19, 25, 26, 55, 59, 62 
Catarrh suffocating, ------ 25, 96 

Catarrhous Fever, with an uncommon imperfect crisis on the 

leg, - - 54 

Cough, hooping, is a contagious disease, - - 35, 36 

how cured, - 36, 37 

Cough, an unusual one, how cured, - - - - 48 
Cholera Morbus described, - - - - 17, 38 

Chicken-pox, ----,.--- 55 



INDEX. 

D 

Dress, the English not so convenient in a hot climate as the 
Oriental, 10, 11 

Diseases peculiar to that climate, 12 

Diseases, inflammatory, frequent there, 15 

Dysenteries, frequent and epidemical there after much 

rain, - - - - - - - 17, 22, 146 

their cure, 22, 23, 37, 38, 48, 50, 53, 57, 58, 63, 

69, 71, 73, 75, 86, 87, 89 
Dysentery, its cause, &c. ..... 145 

— — its method of cure, - 151 

Dry Belly-ache, its cause, &c. - - - - 132 

its method of cure, - - 137, 138 

when attended with inflammation, 34, 55, 56 

Diarrhoea Alba, an uncommon one described, &c, - 75 
Disease, an unusual one, seizing the heads of children there, 74 

E 

Efflorescences, strangers subject to them when they first come, 6 

erroneously ascribed to the biting of the mus- 

quetoes, - ------.7 

Exercise, what proper in that climate, - - - 11 

Essera. (See Prickly-heat) - - - - 7, 58 

Ephemera Fever described, ----- 52 

Elephantiasis, its symptoms, &c. - - - - 218 

its method of cure, - - - 223 



Fevers, inflammatory, frequent, 28, 30, 34, 36, 39, 40, 88 

Fever, slow nervous, ------ 30 

its method 01 cure, - 31, 32, 35, 37, 39, 42, 43 

Fever, putrid, bilious, or yellow fever, - 105 

its cure, - - - - - 114,32,34,39 

continued remitting, - 20, 21, 49, 65, 66, 67, 71 

s, tertians and quartans, rarely seen there, unless brought 

thither, 20 

ephemera, - : - 52 

■ irregular ingeminated, - - - - - 90 

depuratory, wi#i an uncommon crisis, 7Q, 80, 84, 86, 8T 

of the eresipelatose kind, ... 82, 84 



Febricula, 53 

Flux and Reflux of the sea, an unusual one caused by an earth- 
quake, - - 60 



INDEX. 

G 

Gout anomalous, - 51, 57, 58, 64 
Of the Guinea Worm, 228, 230 

H 

Haemorrhoids, ------- 72 

Haemorrhage, an uncommon one from the intestines, 74 

Hemeralopia described, ------ 216 

— — — — its method of cure, - 216 

J 

Jaundice, an uncommon one seizing children, 46 

L 

Leprosy of the Arabians described, - 232 

■■ its method oi cure, - 237 

of the joints, 241 

■ its method ol cure, ----- 243 

N 

Nyctalopia, - - - 213 

O 

Opisthotonos and Tetany, - - 64, 159 

their method of cure, - - - 167 

Ophthalmies frequent, - - - - - % 71 



Peripneumony, - - 27, 35, 37, 39, 55, W, 81, 82 

Pleu-peripneumony, 37, 38, 81 

Pleurisies, - - . - se, 33, 39, 40, 55, 77, 81 
Paraphrenites, ------- 40, 77 

Prickly-heat, or Essera, - - - - - 8, 58 

Pox, Small, - - - - - - - - 16 

— Chicken, -- 55 

R 

Rain, very much fell, - 46, 53 

Rabies Canina described, - - - - - 177 

1 ■ its symptoms in dogs, - - - 179 

- ■ ' its symptoms in men, - - - 181 

— its prophylactic method of cure, - - 185 

■ its therapeutic method of cure, - - 192 



INDEX. 

Of the Ring-worm, - 255 

1 its method of cure, - - - 256 

Rheumatism, inflammatory, - - - 33, 79 

S 

Solids, Animal, much relaxed by heat, ... 9 

the benefit from it, and disadvantages, - 10 

Synochus Febris, - - - - - ' - - 24 

Sal ammoniac and nitre the best attenuants and antiphlogis- 

tics, 28, &c. 

T 

Tetany and its method of cure, - - 64, 65, 167, 159 

U 

Urine, no sediment in it in fevers in this climate, or judgment to 
be formed by inspecting it, --.-.- 20, 67 

Y 

Yaws described, - 245 

their method of cure, - 249 



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